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Washington University Experience | VASCULAR | Atherosclerosis | 12A0 Case 12 History
Case 12 History ---- This was an 83 year old woman who was brought to the ER in an unresponsive state with a known history of hypertension. On the day of admission she was brought in being found sitting up, unresponsive in a chair. She had been started on antihypertensive medication several weeks prior to admission. Physical exam on admission showed a blood pressure of 168/90 with a right 1+ carotid bruit. The clinical impression on admission was that the patient had a probable pontine infarct. Workup included a CT scan which showed no evidence of hemorrhage. Later on August 20th the patient had a cardiac arrest and could not be resuscitated. --- At autopsy the posterior circulation showed extensive atherosclerosis with the basilar, left and right vertebral arteries showing approximately 75% occlusion. Superimposed is a recent thrombus involving the left vertebral artery at the level of the basilar artery, including the outflow of the posterior inferior cerebellar artery and anterior spinal artery. The internal carotid and middle cerebral arteries are approximately 50% occluded by atheromata. The pons and cerebellar hemispheres show recent infarcts and pontine lacunes.
