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Washington University Experience | VASCULAR | Atherosclerosis | 14A0 Case 14 History
Case 14 History ---- The patient was a 95 year old woman with a history of type II diabetes, hypertension, a non-ST elevated myocardial infarction, and a pulmonary embolus as well as multiple abdominal surgeries including a cholecystectomy and total abdominal hysterectomy. The patient also had a history of a ventriculoperitoneal shunt for treatment of colloid cyst and a history of Alzheimer's type dementia. The patient presented to the BJH ED on 2/1 with a one-hour history of abdominal pain and abdominal distension. An abdominal CT on admission showed no evidence of obstruction or perforation. Clinically, the findings were consistent with ischemic bowel, and the patient had elevated lactic acid levels. The patient underwent fecal decompaction and nasogastric suction. The patient aspirated fecal material and developed respiratory failure with hypotension and hypoxemia. Per the patient's living will, there was no escalation of care. The patient was found in asystole and pronounced dead on 2/2. ---- At autopsy the weight of the unfixed brain was 1030 grams. The patient received a diagnosis of Alzheimer's disease and colloid cyst of the third ventricle with ventricular shunting. Vascular disease consisted of remote microinfarcts involving the left basal ganglia and thalamus, arteriolosclerosis, congophilic (amyloid) angiopathy, and severe atherosclerosis.
