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Washington University Experience | VASCULAR | Aneurysm - Giant | 4A0 Case 4 History
Case 4 History ---- The decedent was a 65 year old man with a past medical history significant for a subacute right middle cerebral artery (MCA) territory stroke (right parietal lobe), giant left pericallosal aneurysm diagnosed in 2005 (known to be partially thrombosed) for which the patient refused treatment, seizures (starting 2002), myocardial infarction (5/2011), hypertension, COPD, and a recent hospitalization for pneumonia in 5/2011. He presented in June 2011 to an outside hospital, from a nursing facility to which he had recently been admitted with a decreased level of consciousness, hypotension (84/60) and desaturation (70% on room air). There was concern for meningitis for which he was treated empirically with antibiotics. His mental status improved rapidly with administration of antibiotics and he returned to his baseline. During his workup, among other laboratory evaluations, protein 14-3-3 and tau levels were obtained from the CSF. The tau protein was significantly elevated and the 14-3-3 was equivocal (National Prion Disease Surveillance Center, NPDSC). MRI demonstrated old infarcts as well as a new left sided temporal infarct. He was discharged to his nursing home with a followup examination scheduled but died before that visit. The postmortem tissue was sent to the NPDS and showed no evidence for prion disease. It weighed 1350 grams..
