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Washington University Experience | VASCULAR | Herniation, uncal | 7A0 Case 7 History
Case 7 History ---- The decedent was a 62-year-old female with stage 5 chronic kidney disease on dialysis with poorly controlled hypertension, diastolic heart failure, and COPD who was found unresponsive in her nursing home on 08/02. She was brought to an outside ER where a head CT showed a 1.7 cm thick left acute subdural hematoma with approximately 1.8 cm midline shift and acute hemorrhage in the posterior pons. No bony abnormalities were seen. The patient was put on a ventilator, administered mannitol and was transferred to BJH for further management. On physical exam, she was intubated but not sedated, overbreathed the ventilator and was non-responsive. She had bilateral fixed pupils, a 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, it was decided to forgo surgical evacuation of the hematoma due to the low probability that the patient would make a functional recovery without significant comorbidities, a wish that the patient had previously communicated to her brother. The patient was extubated with family at the bedside and expired 6 hours after admission.
