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Washington University Experience | VASCULAR | Hemorrhage, hypertensive | 50A0 Case 50 History
Case 50 History ---- The patient was a 54 year old man with a history of hypertension, chronic kidney disease, and a right basal ganglia intraparenchymal hemorrhage in March 2025. CT exam at that time showed a 2.3 × 1.8 × 2.2 cm right centrum semiovale/basal ganglia intraparenchymal hemorrhage with mass effect on the right lateral ventricle. The residua of that event resulted in persistent left-sided hemiplegia. The patient was found unresponsive with an unwitnessed out-of-hospital cardiac arrest in early July 2026. The patient’s last known well time was approximately midnight. Emergency medical services arrived at 5:59 AM and initiated advanced life support. In the field, the patient received six doses of epinephrine, 300 mg of amiodarone, 1 L of normal saline, and one ampule of bicarbonate; blood glucose was 136 mg/dL. The patient was intubated. Initial cardiac rhythm was ventricular fibrillation, which subsequently converted to pulseless electrical activity. Despite continued resuscitative efforts, including additional epinephrine and multiple rounds of cardiopulmonary resuscitation, there was no return of spontaneous circulation. The patient remained in pulseless electrical activity without response to antiarrhythmic therapy. Transesophageal echocardiography demonstrated no cardiac activity with swirling blood in the ventricles. Given the prolonged, unwitnessed downtime, lack of response to advanced resuscitative measures, and extremely poor neurologic prognosis, resuscitation was terminated and death was pronounced.
