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Washington University Experience | VASCULAR | Atherosclerosis | 19A0 Case 19 History
Case 19 History ---- The patient was a 68 year old man with an extensive past medical history which included hypertension, dyslipidemia, uncontrolled type II diabetes, alcohol abuse, distant (13 and 17 years) history of cerebrovascular events with left hemiparesis, vitamin D deficiency, left hip fracture (12 years prior), and benign prostate hyperplasia. His strokes were described on imaging to be left cerebellar and right pontine infarcts. He was admitted terminally for left foot and toe cellulitis. He was also described to have uncontrolled diabetes with a HbA1C of 13.7%, adequately controlled hypertension, vitamin D deficiency, on statin and aspirin therapy for cerebrovascular disease treatment. The patient's clinical course near the time of his death remains unknown. ---- At autopsy his unfixed brain weight was 1110 g with global atrophy and numerous recent and remote infarcts involving the left caudate with extension into the septum pellucidum and thalamus, hippocampus, right temporal lobe, left basis pontis and midbrain, spinal cord and bilateral occipital lobes with extension into the subarachnoid space. The basilar and vertebral arteries showed 70-90% occlusion and recanalization. The findings of cardiomegaly (740g) with bilateral ventricular hypertrophy, coronary artery atherosclerosis, presence of myocardial fibrosis and left papillary muscle subacute infarct, favor a cardiac cause of sudden death in this patient.
