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Washington University Experience | VASCULAR | Infarct - Embolic | 10A0 Case 10 History
Case 10 History ---- The patient was a 63 year-old man with a history of congestive heart failure who was admitted to an OSC on 12/5 with pneumonia, left upper extremity weakness, dysarthria and 20-pound weight loss over 2 months. Two lung masses were identified earlier in that year, but mediastinal biopsies were nondiagnostic. He had jugular vein thrombosis and was on coumadin which was discontinued due to nosebleeding. He also had myocardial infarction in 1993, cardiomyopathy with congestive heart failure, AICD for ventricular tachycardia in 1997, hypertension, and rheumatoid arthritis. He smoked cigarettes 3 ppd for 40 years. Lab tests were significant for elevated WBC (13,200, 90% neutrophil), low platelets (43,000), and INR 2.1, GGT 96, AST 53. Head CT scan on 12/9 showed a subacute infarct in the right frontal and periventricular white matter area. The physical examination upon admission to BJC was significant for tachycardia, somnolence, dysarthria, nonsensical speech, left sided weakness and facial droop. At 2200 on 12/11, he was found tachypneic and unresponsive, and developed cardiac arrest. He was resuscitated, intubated and transferred to the ICU, where 4 hours later, he again suffered cardiac arrest. His pupils were fixed and dilated. He developed acute renal, hepatic, respiratory, and cardiac failures. His family decided to withdraw life support and he was pronounced dead on 12/12. ---- The autopsy findings include numerous hemorrhagic, macroscopic (right frontal and insular cortex) and numerous microscopic infarcts involving cerebral hemispheres diffusely with superimposed edema. Many infarcts have multiple microemboli. The general autopsy findings demonstrated widely metastatic adenocarcinoma; however, neoplastic deposits were not identified in the CNS.
