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Washington University Experience | VASCULAR | Infarct - Acute | 1A0 Case 1 History
Case 1 History ---- The decedent was a 73 year old man with hypertension who died of a basilar artery thrombosis. His symptoms started 3 weeks previously with an episode of slurred speech, vertigo, and a left field cut for which he was hospitalized and found to have an occipital infarct. After discharge, he had recurrent episodes of diminished level of consciousness, slurred speech, and dizziness. On 2/9, he again developed diminished consciousness that did not resolve within 15 minutes. In an OSH ED, he returned to baseline, but became comatose before being discharged home. He was transferred to our facility, arriving comatose with sonorous respirations. He had left gaze deviation with reactive pupils, roving eye movements with ocular bobbing, and decreased/absent corneal, gag, and oculocephalic reflexes. He extended his upper extremities to pain, and triple flexed his lower extremities. His exam worsened over 24 hours and his care was made comfort measures only. He expired on 2/13. ---- At autopsy the weight of the unfixed brain was 1,580g. Basilar artery thrombosis with recent infarct involved the upper brainstem as well as thalami and caudal basal ganglia, inferior medial aspects of temporal and occipital lobes, and superior cerebellar hemispheres bilaterally. A small subacute cerebellar infarct was found which may represent his initial scan-visualized “occipital” lesion.
