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Washington University Experience | NEURODEGENERATION | Neuronal Nuclear Inclusion Disease (NIID) | 4A0 Case 4 History
Case 4 History ---- The patient was an 89 year old female with a past medical history of hypothyroidism, S/P thyroid removal, rheumatoid arthritis, temporal arteritis treated with steroids, and a positive VDRL for which she was treated. She was discharged from BH on 7/23/90 after being treated for lower extremity cellulitis. Her friends noted that her cognition had declined and that since her last hospitalization, her mental status had waxed and waned; she had no history of dementia . On 7/28 her guardian/attorney found her confused and disoriented and she was taken to BH . Her medications included prednisone, thyroid extract, Mitrobid, Procardia, Zantac, and Lasix. There was no history of alcohol abuse and family history was unremarkable. On exam, she was febrile with a temperature of 38°C and had signs of dehydration. She was easily arousable to verbal stimuli but did not respond. Her right pupil reacted but her left did not. Her sodium was 118 with a chloride of 79, raising the possibility that she had taken too much Lasix. Head CT was consistent with atrophy and lumbar puncture was negative. She was admitted, started on stress doses of steroids, and her sodium was corrected to 130 after 24 hours. The day after admission she had a general tonic clonic seizure with eyes deviated to the right and was started on Dilantin. After a second seizure she had no response to any stimulus and had a left gaze. She was started on antibiotics for a right middle lobe pneumonia. Over the next two days, she had several more seizures and was intubated on 8/1. She continued to seize for the next 8 days. Her hospital course was complicated by a self-limited sigmoid colon bleed, persistent hypotension treated with pressors, persistent fevers with worsening pulmonary infiltrates, and congestive heart failure. Right-sided seizures persisted with therapeutic levels of Dilantin, phenobarbital and valproate. On 8/7 she became oliguric and hypotension worsened. It was decided that given the prolonged status epilepticus, her prognosis was very poor and she was weaned from her anticonvulsants and passed away.
