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Washington University Experience | VASCULAR | Herniation, tonsillar | 6A0 Case 6 History
Case 6 History (AANP 1994, Case 10) ---- This was a 10 year old boy with a history of attention deficit disorder, hyperactivity and asthma. A week before admission he developed an upper respiratory tract infection for which he was receiving Penicillin. On 2/10/93, he was playing basketball when he suddenly complained of headache with dizziness and he collapsed. He was taken to the ER of a nearby hospital. He was found to be unresponsive, tachycardic to 140 BPM and apneic. He was immediately intubated. A chest x-ray showed bilateral pulmonary infiltrates consistent with pulmonary edema. A CT-scan showed a cerebral hematoma with some bleeding into the third ventricle and acute hydrocephalus. He was then transferred for further management and taken to the Operating Room for an emergency right frontal ventriculostomy. The CSF was found to be under high pressure and was bloody. On the operating table, the patient was noted to have no spontaneous respirations, no response to deep painful stimuli and had fixed and dilated pupils, consistent with absence of all brain stem functions. The patient remained comatose. An EEG showed minimal cortical activity at this time. He was maintained on ventilatory support. Neurological criteria for brain death were evaluated and confirmed on 2/13. On 2/14 multiple organ harvesting was carried out. Subsequently an autopsy was performed, 67 hours after death. ---- This is an example of displacement of cerebellar tissue from herniated cerebellar tonsils. It is generally seen only in patients who have been on a respirator.
