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Washington University Experience | VASCULAR | Herniation, uncal | 6A0 Case 6 History
Case 6 History ---- The patient is a 35 year old woman with a history of severe mitral valve stenosis, for which she underwent valve replacement in 2000. She had been treated with Coumadin, but was switched to subcutaneous heparin when she became pregnant in December, 2004. In January 2005, she developed a renal embolus. She was hospitalized at Stanford University and had an extensive evaluation that raised the possibility of antiphospholipid antibody syndrome. She had a porcine valve replacement at that time. Since then, she had been doing well. In December, 2005, she experienced a seizure and was hospitalized. A brain MRI showed bifrontal hemorrhages only on the contrast enhanced images. She was intubated and sedated, and transferred to another hospital the next day. The lab data showed WBC of 17300 and INR of 1.2. An MR arteriogram showed abnormalities in the left middle and anterior cerebral arteries and the right anterior cerebral artery. A brain MRI showed findings suspicious for frontal infarction and old small lesions suspicious for multiple hemorrhagic emboli. A brain CT showed edema, ventricular compression and entrapment of the right lateral ventricle. EKG showed no ischemic changes or atrial fibrillation. The patient expired at the end of December.
