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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Leukotomy, Surgical - (Archaic Schizophrenia Rx) | 1A0 Case 1 History
Case 1 History ---- The patient was a 77 year old female who presented to BJH ER in cardiac arrest and failed to be resuscitated. She carried a diagnosis of emphysema, schizophrenia, dementia, and chronic seizure disorder. She was initially noted to have behavioral problems of paranoia, irritability, and impulsiveness when she was in her early 20s. However, she was noted to have an IQ of 140 and was able to finish 12th grade education and carried a job as a hairdresser. She underwent elective lobotomy when she was 34 years old for the "behavioral problems". She was noted to be more "docile" and "quiet" since the surgery. Her sister denied that the patient had a history of auditory of visual hallucination. However, she was noted to "live in a fantasy world" since the surgery. She retired from her job. Her sister did not note dementia, and she was independent in activities of daily living except financially. Her husband sent her to a nursing home in her 50s because of her continuous behavioral problems and he could no longer take care of her. She continued to be independent in her activities of daily living and active in the nursing home. She was fully ambulatory and participated in a daily rehabilitation program six days a week. Her diagnosis of "seizure disorder" was made prior to admission in the nursing home, and she was on valproic acid with no report of recurrence. She was on Zyprexa (20 mg, qhs) and Lorazepam (0.5 mg) for her psychiatric disorder. She was also noted to have tardive dyskinesia, but with no akinesis, postural instability or tremors. She was last seen by her sister in October 1999 and was noted to be "healthy". The patient was witnessed to have "cardiac arrest" per nursing home staff in January 2000 and EMS was notified. Upon arrival, the patient was noted to be unresponsive, pulseless with no spontaneous respiration. Large pieces of food were found in her throat when EMS tried to establish an airway. Other than psychiatric disease, the patient's past history is significant for emphysema. There is no history of diabetes, coronary artery disease, or stroke. She continued to be a smoker. There was no history of ETOH abuse. There was no family history of early dementia, Parkinson's disease, stroke, seizure, or psychiatric disorders.
