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Washington University Experience | VASCULAR | Herniation, uncal | 3A0 Case 3 History
Case 3 History ---- This 69 year old man was admitted on the morning of 6-21, after having been discovered unresponsive at home. No history of antecedent neurologic disease was obtained and very little was known prior to this incident. He was unresponsive to verbal stimuli and Kussmaul respirations were noted. Ecchymoses were observed over the right cervical and left occipital regions. Pupils were 3.0/5.0 mm and unresponsive to light. There were no EOMs to OCM or cold caloric testing. Flexor posturing was noted with noxious stimuli. CT scan showed a large left frontoparietal intracerebral hematoma with left-to-right shift and extension into the lateral, third and fourth ventricles. His condition was unchanged throughout his hospital course, and approximately 48 hours after admission, spontaneous respirations ceased. ---- At autopsy the epicenter of the hemorrhage was at the level of the left lentiform nuclei and was thought to represent a hypertensive pathogenesis (supported by marked cardiomegaly). Bilateral cerebral edema also contributed.
