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Washington University Experience | VASCULAR | Infarct - Embolic | 2A0 Case 2 History
Case 2 History ---- This was an 87-year-old woman with a history of hypertension, Alzheimer’s type dementia, and a subarachnoid hemorrhage which began on 12/28 presenting with the acute onset of severe headache. Head CT in the ER showed extensive blood in the basal cisterns as well as diffusely over the hemispheres; an angiogram revealed a 4 mm anterior communicating aneurysm, which was coiled endovascularly. On April 19, she was re-admitted to the ER after resuscitation from cardiac arrest at home. EMS performed CPR in the field, and upon arrival she briefly had a pulse but ultimately was not resuscitated. ---- At autopsy the brain weighed 1170 grams and showed discoloration in the right frontal lobe adjacent to the aneurysm and was accompanied by a second area of softening in the left occipital lobe. The microvasculature in the leptomeninges, cerebral cortex and subcortical white matter is markedly atherosclerotic and arteriolosclerotic. Many vessels contain fragments of atheroemboli in association with infarcted cortex, particularly in the occipital lobe. There is no evidence of vasculitis. The cerebellum is remarkable for multiple ischemic lesions ranging from selective Purkinje and granule cell loss with Bergman’s astrocytosis to frank cystic infarction with numerous atheroemboli. Other sites with emboli and infarction include the brainstem and spinal cord
