Table of Contents
Washington University Experience | VASCULAR | Cardiac Arrest Encephalopathy | 7A0 Case 7 History
Case 7 History ---- The patient was a 72 year old man with a past medical history significant for depression and a gradually progressive movement disorder. He first noted rest tremor in his hands 13 years prior with multiple spells where he fell out of bed and sustained significant trauma including fractures and subdural hematoma. He was treated with carbidopa/levodopa with unclear benefits. His orthostatic symptoms responded well to fludrocortisone. He had also started noticing short term memory problems. Late in his course he also started having nocturnal hallucinations. Quetiapine failed to adequately relieve his symptoms; however, clozapine significantly improved his psychosis but with worse daytime somnolence and parkinsonism. His balance problems continued to progress with daily freezing spells and falls. He was admitted to BJC shortly before his death with worsening Parkinsonism, psychosis and daytime somnolence. He was ultimately discharged to a skilled nursing facility on 9/22 but decompensated the same night, lost pulse and stopped breathing in the ambulance en route to the hospital. He was intubated on arrival at the ER, started on pressors and transferred to ICU. He was found to have a bleeding ulcer which was cauterized. His initial head CT was reportedly unremarkable. He failed to improve adequately over the next 48 hours requiring ventilator support. His wife decided to withdraw support the afternoon of 09/25 and he died, three days after his arrest and resuscitation. ---- At autopsy the fresh brain weighed 1295 grams and showed diffuse hypoxic/ischemic damage. Inflammatory changes, however, were confined to the brainstem.
