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Washington University Experience | VASCULAR | Infarct - Acute | 9A0 Case 9 History
Case 9 History ---- The patient was a 66 year old woman with a past medical history of triple negative metastatic invasive ductal carcinoma of the breast, chronic kidney disease secondary to hypertension and diabetes mellitus, type 2, cerebrovascular accident, and congestive heart failure with ischemic cardiomyopathy. She presented to the ER after an apneic episode which was preceded by nausea and vomiting on 9/10. The patient's son, who called EMS, began cardiopulmonary resuscitation and the patient began breathing again. Earlier that day, the patient had had a chemotherapy port placed and was given a dose of Paclitaxel. In the ER it was thought that the patient had experienced a vaso-vagal episode. Her creatinine had increased upon admission from a baseline of 1.2 to 2.0, which continued to trend upward throughout her hospital stay to 3.6 before she passed away. The patient also experienced multiple episodes of bradycardia and bigeminy with an increase in serum troponin. On 9/16 the patient experienced a bradycardic event that was not treatable with atropine and expired. ---- At autopsy the weight of the unfixed brain was 1210g. The brain showed metastatic breast carcinoma involving the frontal lobe, thalamus, medulla and cerebellum. The focal ischemic lesion in the spinal cord was incidental.
