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Washington University Experience | VASCULAR | Edema - Cerebral | 3A0 Case 3 History
Case 3 History ---- The patient was a 33 year-old woman with a history of schizophrenia and chronic migraine headache who was transferred here on 11/8 after being treated for headache and acute hepatic failure at an OSH. Her illness began on 11/5 with headache, nausea and vomiting with a question of acetaminophen overdose. She had elevations of AST (4000) and ALT (2000), was treated in an ER and sent home twice. She was admitted to an OSH days later with mental status changes and intermittent generalized seizures on 11/7. Head CT and urine drug test were negative. She was transferred to BJH for possible liver transplant. Physical examination showed fixed and dilated pupils, positive cough and Doll’s sign reflexes, and triple flexion of lower extremities. Head CT on 11/8 showed diffuse cerebral edema and a bolt was placed. Laboratory studies showed AST 2300, ALT 310, total bilirubin 4.6, direct bilirubin 2.9, Pro 6.3, PT 16.3, INR 137 and ammonia 405. Support was withdrawn, and the patient was pronounced dead on 11/9. ---- Autopsy results included diffuse cerebral edema with acute hepatic encephalopathy and acute hypoxic/ischemic encephalopathy likely worsened by intermittent generalized seizure activity. Hepatic failure, possibly due to acetaminophen overdose, lead to extensive centrilobular necrosis. Fulminant hepatic failure can cause neurologic alterations and death in cases which reach grade IV coma within hours or days.
