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Washington University Experience | VASCULAR | Hemorrrhage - Subdural | 7A0 Case 7 History
Case 7 History ---- The decedent was a 62-year-old woman with stage 5 chronic kidney disease on dialysis, with poorly controlled hypertension, heart failure, and COPD. Per records, she was living in a nursing home and acutely developed altered mental status. She initially was taken to an OSH and intubated for airway protection. A head CT demonstrated a large, 1.7 cm thick left-sided acute subdural hematoma with approximately 1.8 cm of midline shift. The patient was placed on a ventilator, administered mannitol and transferred to BJH for further management. On physical exam, she was intubated but not sedated, overbreathed the ventilator, was nonresponsive, had bilateral fixed pupils, with weak corneal reflex on the right, had a cough and gag reflex, weakly extended bilateral upper extremities, and triple flexed bilateral lower extremities. After discussing the clinical situation with her family, surgical evacuation of the hematoma was not performed based on the patient’s past request. The patient was extubated with family at the bedside and expired on 08/02. ---- At autopsy the weight of the unfixed brain was1240g. A large left hemispheric subdural hemorrhage was found. Coronal sections of the cerebral hemispheres revealed a normal cortical ribbon, underlying white matter, basal ganglia, and thalamus. There was compression of the left lateral ventricle and dilation of the right lateral ventricle. The unci were discolored with left uncal grooving and were tightly applied to the midbrain consistent with uncal herniation. The patient developed a large subdural hematoma without a history of trauma or hemorrhage in the skull or scalp.
