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Washington University Experience | NEURODEGENERATION | Neuronal Nuclear Inclusion Disease (NIID) | 2A0 Case 2 History
Case 2 History The patient was an 81 year old female with a history of B-12 deficiency, past right internal capsule stroke, and senile dementia of the Alzheimer's type who presented to BH on 12/19 with a four hour history of dyspnea. She was intubated in the field by EMS and in the ER was found to be hypotensive, unresponsive, and exhibiting a right gaze preference. Neurologic exam revealed an elderly woman who opened her eyes but did not follow commands. Pupils were reactive, there was a right gaze preference but full extraocular movement to doll's maneuver, a flattened left naso- labial fold, and diffuse hypertonia without asymmetry in the movement of her extremities. Plantar responses were flexor on the right and extensor on the left. CT scan of the head revealed marked diffuse cortical atrophy with ventriculomegaly, particularly of the lateral and third ventricles, and periventricular white matter lucencies. Pertinent admission laboratory data included a sodium of 166, a chloride of 131 and a white blood cell count of 3.8 with 45 segs, 40 bands and 3 metamyelocytes. She was found to have pneumonia and developed disseminated intravascular coagulation and acute renal failure. Her neurological examination showed gradual deterioration, and eventually life support was withdrawn. On day 8 of her hospital course the patient died.
