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Washington University Experience | VASCULAR | Hemorrrhage - Subdural | 5A0 Case 5 History
Case 5 History ---- The patient was a 61 year old woman with a history of multiple myeloma, status-post autologous bone marrow transplant in 1998. She also had a history of GI bleed, hypertension, deep venous thrombosis and peripheral neuropathy. She was admitted to BJH on 4/8 with complaints of tremulousness, confusion, malaise, and poor appetite. Outpatient labs just prior to admission showed a Creatinine of 7.7 and WBC of 30.9. On 4/9 a dialysis catheter was placed in the right femoral vein and she underwent hemodialysis on the morning of 4/10. Exam afterward showed her to be confused and lethargic with generalized myoclonus. Her condition deteriorated and early on 4/11, she was found with Cheyne-Stokes respirations and was difficult to arouse. Shortly thereafter she became apneic and expired. ---- At autopsy the weight of the unfixed brain was 1220g. The sulcal-gyral pattern was normal apart from an area of indentation involving the right frontotemporal area coinciding with the area of overlying subdural hemorrhage. Sections of the hematoma showed an acute/subacute hemorrhage with focal fibrinous organization, although no definite internal or external fibrous membranes had been formed. The subdural hemorrhage present in this patient is acute/subacute, likely precipitated by her coagulopathy.
