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Washington University Experience | VASCULAR | Atherosclerosis | 16A0 Case 16 History
Case 16 History ---- The patient is a 53-year-old man with a history of prior, multifocal strokes, initially diagnosed one year prior to surgery. The most recent stroke occurred in August 2014, 1 month prior to his last admission. The patient also had a history of chronic kidney disease with a baseline creatinine of 1.3, as well as hypertension, hyperlipidemia, diabetes mellitus, and a roughly 40 pack-year smoking history. The patient most recently presented in September 2014 with another episode of transient ischemic attack. In August 2014, angiography showed diffuse vessel caliber changes concerning for vasculitis. However, serologies were negative for ANCA and showed normal levels of C3 and C4 complement. Due to a concern for intravascular lymphoma, skin and muscle biopsies were performed in August 2014, which were negative. Work-up for coagulopathy showed a normal INR of 1.15 and a normal platelet count of 252K. MR imaging performed September 12 showed multiple resolving and some new areas of T2 hyperintensity with associated diffusion restriction in the subcortical white matter of the cerebral hemispheres and cerebellum. Susceptibility-weighted sequences revealed no evidence of acute or chronic hemorrhage. Operative procedure: Right frontal open biopsy.
