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Washington University Experience | VASCULAR | Infarct - (Pseudo) Laminar necrosis | 10A0 Case 10 History
Case 10 History ---- The patient was a 39 year old right-handed female with a history of Cushing's disease who was admitted for the resection of a pituitary adenoma. The patient had a 10 month history dysmenorrhea, hirsutism and a 70 pound weight gain. She denied any polyuria, polydipsia or galacturia. She underwent an MRI scan which revealed a left-sided pituitary adenoma. The patient underwent a transsphenoidal resection of her pituitary adenoma on January 2001. Following surgery she was extubated, but immediately experienced a decreased oxygen saturation level. Due to her large size she was unable to be successfully mask ventilated. A direct laryngoscopy showed pharyngeal swelling and multiple attempts at intubation were unsuccessful. She then became bradycardic and asystolic. CPR was initiated per ACLS protocol. The code lasted approximately five to six minutes and then the patient's vital signs returned to normal with 100% oxygen saturations. She was transferred to the Neurosurgery ICU for monitoring. On arrival in the ICU she had intact cranial nerve function with extensive posturing of her upper extremities and flexion of her lower extremities. She was also treated immediately with triple antibiotics for aspiration pneumonia. Follow-up head CT following the event was unremarkable as well as an MRI scan performed two weeks after the episode. The patient's neurologic status only minimally improved throughout the rest of her hospitalization. On postoperative day 12 she was noted to have swelling of the lower extremities and underwent Doppler studies which revealed bilateral common femoral DVTs. She then had an IVC filter placed. Over the ensuing two weeks the patient continued to show no evidence of neurologic improvement. The family then decided to withdraw support and the patient expired.
