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Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | Porencephaly | 8A0 Case 8 History
Case 8 History ---- This 57 year old man with hypertension, hypercholesterolemia and a long cigarette smoking history with numerous adult cardiac problems was admitted in April 1980 and expired after a one month course in the Coronary Care Unit. However, he had a poorly characterized birth history resulting in congenital left hemiparesis and hemiatrophy; accompanied by flexion contractures. This neurologic disability had not apparently impaired the patient intellectually. There was no history of neurologic disability in his parents, siblings, or children. He had no history of seizures, prior strokes or history of head trauma. The patient was admitted to BJH in March 1980 with prolonged chest pain and pulmonary edema, which was diagnosed as a third MI. Later he again developed chest pain and pulmonary edema. The patient had an extremely rocky CCU course with frequent episodes of shortness of breath and pulmonary edema associated with ischemic EKG changes. He developed Klebsiella pneumonia which worsened and bronchial washings subsequently grew Staphlococcus aureus and Enterobacter. He was found unresponsive. A neurologic examination found the patient unresponsive to commands, but would follow light with his eyes. Doll's eyes were intact. The clinical impression was that the patient had experienced a toxic encephalopathy due to multiple factors. On May 26, ventricular fibrillation developed. CPR was not initiated at the family's request and the patient expired.
