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Washington University Experience | VASCULAR | Aneurysm - Saccular | 12A0 Case 12 History
Case 12 History ---- The patient was admitted and expired within 24 hours. The patient was a 64 year old woman with a prior history of breast cancer 8 years previously. A bone scan showed destructive lesions of spinous processes of L3-5 which was thought to be consistent with metastatic disease. The patient remained well until a few days prior to admission when she developed a right frontal headache. Later that day she complained of a right orbital headache "like her eye was coming out of head". Shortly thereafter the son called to her and noted the patient’s voice sounded unusual. He opened the door and found her sitting on the floor, slumped against the wall. The patient vomited one time and was noted to have grasping movements both hands. She was brought to Barnes Hospital ER where she was noted to be unresponsive with no spontaneous movement, left sided extensor posturing to noxious stimuli with fixed mid position pupils and bilateral papilledema; she was given Decadron IV push and Mannitol. Physical examination revealed a comatose elderly woman with Cheyne-Stokes respirations. HEENT examination revealed bilateral papilledema with retinal hemorrhages. Neurological amination revealed a comatose unresponsive patient with weak extensor posturing the upper extremities and lower extremities. There were no ocular movements to ice water calorics and her pupils were 4/4 and unreactive to light. ·There was no response to corneal stimulation, no facial grimace, and no gag. Reflexes were 1 to 2+ and both toes were up with the Babinski maneuver. Stat CT scan showed a right frontal lobe hemorrhage with rupture into the right lateral ventricle and a questionable isodense mass in the right parietal region. The patient was admitted to the neurology service were she remained deeply comatose with 4 mm pupils, irregular and unreactive. There were no spontaneous eye movements or oculocephalic reflex. She expired on 2/15
