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Washington University Experience | VASCULAR | Infarct - Acute | 8A0 Case 8 History
Case 8 History ---- The patient was a 62 year old woman who presented on 2/18 with acutely developing mental status changes. She had complained of headache on the previous day, and by the time she presented to the ER had become very agitated and anxious with unclear speech. The initial impression of a neurology consultant was encephalopathy of unclear etiology. A lumbar puncture showed pleocytosis of the CSF, although there was neither bacteriologic growth on culture nor any bacteria seen by Gram stain. Her EEG was abnormal with bilateral frontotemporal epileptiform discharges. CT scan was still grossly normal but MRI of her brain was abnormal revealing cerebral edema and suggesting diffuse cerebritis. The patient's mental status then deteriorated and she became unresponsive. Due to progression of respiratory distress, she was intubated and placed on mechanical ventilation. On 2/22, intracranial pressure was elevated. Another MRI revealed infarcts involving the bilateral temporal, parietal and occipital lobes which was a new finding. By 2/23 the patient was regarded as essentially brain dead and a biopsy was cancelled. After discussion with the family, mechanical ventilation was ended and the patient passed away on 2/23. ---- At autopsy the weight of the unfixed brain was 1490g with cerebral edema accompanying severe hypoxic/ischemic damage ranging from selective neuronal necrosis to frank infarction involving frontal, temporal and occipital lobes, basal ganglia, thalamus, cerebellum and brainstem. Bilateral uncal herniation resulted in Duret hemorrhages involving midbrain and pons.
