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Washington University Experience | VASCULAR | Aneurysm - Fusiform, Dolichoectasia | 5A0 Case 5 History
Case 5 History ---- This 54 year old deaf woman was admitted to an outside hospital after approximately 8 days of headaches and 99-103° fever. She was slightly lethargic, confused and complained of a frontal headache and a stiff neck. A neurologist found her sensorium to be markedly impaired and her neck to be quite stiff in the absence of localizing signs. An LP showed an opening pressure of 210 mm, white count of 2300, protein of 248, and glucose of 9. The culture subsequently grew Pseudomonas aeruginosa and she was started on antibiotics. Some improvement in her sensorium was noted in spite of hyponatremia secondary to inappropriate ADH. She was transferred to BJC where neurologic exam did not reveal any lateralizing signs. Her mental status was essentially normal. A revision mastoidectomy and meatoplasty was performed along with removal of a cholesteatoma. At the time of the surgery, an exposed temporal lobe was noted in the mastoid and middle ear. Subsequently the patient was alert and cooperative without focal deficit. However, the following day a mild left hemiparesis was noted, and she continued to drain clear to cloudy fluid out of her right ear. Fever and stiff neck were noted. A right brachial angiogram was performed revealing a right to left shift posteriorly of 3.5 mm. Aneurysmal dilatation of the basilar artery was noted. The patient was found apneic and unresponsive on the evening of 10-19 and did not significantly improve neurologically following resuscitative measures. Her neurologic condition continued to be extremely poor until early November, when she showed some mild responses to stimuli. On 11/18, antibiotics for the CNS infection were discontinued and subsequent cultures were negative. By 12/15, her mental status was improved to the point that she was following some commands, but had a persistent quadriparesis. On 1-18, she again spiked a fever and a urinary tract infection was documented. She arrested again following transfer to the Plastic Surgery Service for care of her decubitus ulcer. She did not recover.
