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Washington University Experience | VASCULAR | Infarct - (Pseudo) Laminar necrosis | 8A0 Case 8 History
Case 8 History ---- The decedent was a 12 yo white male with a past medical history of chronic constipation, depression and ADHD who originally presented to St. John’s hospital with a two week history of increasing dyspnea. A work up there revealed a right lower lobe infiltrate. He was intubated for progressive respiratory failure and transferred to SLCH for further care. ECMO was initiated and discontinued 10 days later in the context of multiorgan failure including renal dysfunction for which he was placed on continuous venovenous hemodialysis. Dialysis was discontinued secondary to multiple filter clots and high blood pressure. In an attempt to reinitiate dialysis a left internal jugular catheter was placed. That evening, he became acutely comatose. A head CT was normal but a subsequent MRI revealed bilateral diffuse cortical infarcts. He was found soon thereafter to be apneic in asystole and was pronounced dead. ---- Autopsy findings included thrombosis of the superior sagittal sinus, transverse sinus and straight sinus resulting in extensive subacute infarction of the cerebrum, cerebellum and right basal ganglia and edema with terminal bilateral tonsillar herniation
