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Washington University Experience | VASCULAR | Cavernous Angioma | 21A0 Case 21 History
Case 21 History ---- The patient was a 73-year-old female with a history of severe hemorrhagic cerebral vascular accident in 2011 with resultant spastic quadriplegia and paralysis, acute renal failure (secondary to poor oral intake), altered mental status (secondary to dehydration and urinary tract infection), and hypercalcemia. Recently, her relatives they stated that the patient had not been herself within the past 3-4 weeks. She had been having poor oral intake and was unable to swallow. In the past 2-3 days, she had became more lethargic. She went from basically alert and oriented times two to alert and oriented times zero. As a result, Barnes Extended Care sent her to the emergency room for further evaluation and management. In the emergency room, the patient she was hypercalcemic with ionized calcium of 6.85 and a calcium of 14.3. They also found her with acute kidney injury with an elevated creatinine from a baseline of 0.6 to 1.36 with signs of a urinary tract infection. Neurology recommended medical admission for metabolic causes causing altered mental status. In the emergency room, a head computed tomography showed stable chronic small vessel ischemic disease with old bilateral anterior cerebral artery territory strokes having encephalomalacia; but no acute processes were seen. Shortly thereafter the patient was found pulseless in her bed.
