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Washington University Experience | VASCULAR | Atherosclerosis | 9A0 Case 9 History
Case 9 History ---- The patient was a 65 year old man with a history of COPD, deep vein thrombosis, and a remote cerebral vascular accident, who presented to BJH on 9/13 as a transfer from an OSH with a three day history of increased shortness of breath. One and half months prior to this admission, the patient had a second stroke and his activity was then limited to bed and chair. Following this transfer the patient was unresponsive, pupils were contracted and unresponsive to light, without spontaneous movement of left arm but withdrew it from pain stimuli on both sides. The patient was considered to have respiratory failure and cardiogenic shock secondary to pulmonary embolism. He was immediately intubated and ventilated. On 9/14, the patient developed hypotension and asystole. Maximal intervention and CPR were unsuccessful. ---- Autopsy showed that the arteries at the base of the brain were involved by moderate to severe atherosclerosis, most predominantly involving the basilar artery and the right vertebral artery. Coronal sections revealed an infarct measuring 5 x 3 x 2 cm, involving the right temporal and occipital lobes. Sections of the spinal cord showed thickened, hyalinized small vessels, which are also noted in multiple cerebral and cerebellar sections. In addition, a thrombus is present in the basilar artery, occluding more than 75% of the lumen.
