Table of Contents
Washington University Experience | VASCULAR | Atherosclerosis | 1A0 Case 1 History
Case 1 History ---- This patient was a 73 year old man with a history of hypertension, a 5 pack a day cigarette smoking habit, cardiomegaly, and multiple myocardial infarcts who awoke on 1/20 with slurred speech, left arm and leg weakness and an upgoing left toe. He developed a cold pulseless left leg and a thrombus was removed surgically. A CT scan on 1/24 showed two lucent areas in the right cerebral hemisphere. He then progressed to respiratory and renal failure. On 1/28 a neurological consultation was obtained when the patient developed seizures, decreased left facial grimacing and a flaccid left hemiplegia. IV Dilantin was given. A repeat CT scan showed no evidence of an intracranial bleed to account for the acute onset of seizures. He continued to improve slowly for several days but on 2/4 he suffered an acute cardiorespiratory arrest. An EKG showed a new right bundle branch block. He remained unresponsive but improved enough to be taken off the respirator. On 2/14 an EEG was done which was thought to be abnormal with a very slow background. His condition was thought to be suggestive of a locked-in-state. Repeated attempts by a neurology consultant to establish a communication code with the patient were unsuccessful. All medications were stopped except for Dilantin and he quietly passed away. ---- Autopsy showed multiple areas of subacute infarction including the right putamen and internal capsule, right parietal-occipital lobe, accompanied by right and left hemispheric laminar necrosis. There were multiple systemic infarcts but no embolic source was discovered.
