Table of Contents
Washington University Experience | VASCULAR | Herniation, uncal | 5A0 Case 5 History
Case 5 History ---- The patient was a 48 year old man with history of chronic alcohol abuse. On 07/04 he was drinking with family and was not feeling well. His fiancé assisted him to his room to rest and left. She returned to find him unresponsive with dried blood around his mouth. There was no history of trauma. The patient was unresponsive to painful stimuli, and had no gag or corneal reflexes in the ED. His Glasgow Coma Scale was 3 and he had a core temperature of 30.4oC. A head CT at the ED showed extensive intraparenchymal hemorrhage in left frontal and parietal regions extending into the lateral ventricles with hydrocephalus. CT also noted a left to right subfalcine herniation as well as a left uncal herniation. Diffuse and bilateral subdural and subarachnoid hematomas in both hemispheres and posterior fossa were also noted on CT in the absence of skull fractures. The patient was found to be coagulopathic with INR of 2.07 and thrombocytopenic (platelet 56K). His blood ETOH was 192 mg/dl. Urine toxicology was negative. First exam by a neurology consult showed unreactive pupils with no corneal reflex, dolls eye movement, and lack of movement to noxious stimuli, findings consistent with brain death. The patient subsequently developed progressive tachycardia with dropping blood pressures and became pulseless. His family at that time decided to withdraw CPR and the patient expired on 07/04. (History used previously for additional hemorrhage)
