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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Fat Embolism | 9A0 Case 9 History - Copy
Case 9 History (AANP 2012 Case 4) ---- This 60 yo man presented in August, 2010 with jaundice. The diagnosis of cholangiocarcinoma causing biliary obstruction was made by liver FNA. Based on CT scan at presentation, the tumor was known to be metastatic to liver, lungs and iliac/sacrum. His past medical history included hyperlipidemia, hypertension, and gastroesophageal reflux. He was admitted for jaundice and renal failure. He had endoscopic retrograde cholangiopancreatography (ERCP) and a stent was placed, but it was not effective. Shortly thereafter, he developed acute renal failure and was placed in hospice. Two days before death he was confused. He died on 10/05 following two grand mal seizures. There was no other neurological history and no neuroimaging. ---- General Autopsy: Intrahepatic cholangiocarcinoma, metastatic to the lungs. A common bile duct metal stent was intact and patent; there was splenic and pulmonary congestion, pancreatitis, jaundice, acute and chronic peritonitis, atherosclerosis and an incidental colonic ganglioneuroma. ---- Neuropathology: The fresh brain weighed 1400 g. There was a small fresh subarachnoid hemorrhage over the right parieto-temporal region. The cortical ribbon was grossly intact. There were scattered prominent vessels or petechiae, some with tan discoloration, in the cerebral white matter. Deep gray nuclei and hippocampi were unremarkable. The basis pontis and bilateral middle cerebellar peduncles had multiple round hemorrhagic areas measuring up to 0.3 cm in maximum dimension in a mostly symmetric distribution.
