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Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 14A0 Case 14 History
Case 14 History ---- The patient is an 82 year old man who was found slumped over in the bathtub on the evening of admission and was apparently incoherent at that time. The patient does have a past medical history of hypertension but was currently on no anti-hypertensive medicines. Past medical history is also pertinent in that the patient has had puncture of a right renal cyst approximately one year ago and also had a retropubic prostatectomy one year ago for BPH. Blood pressure on admission to the emergency room was 270/150. On examination in the ER the patient was unresponsive, comatose, and had bilateral decerebrate posturing to noxious stimuli. He had agonal spontaneous respirations and required intubation and artificial ventilation. There were no doll's eyes and no response to caloric stimulation. The pupils were 4 mm and equal; the right pupil was not reactive, the left pupil was status post iridectomy. The fundi appeared benign with sharp margins. There was bilateral decerebrate posturing with ankle clonus bilaterally. Sensation was intact only to deep pain and caused the decerebrate posturing. An EMI scan done at that time showed a massive right hemisphere bleed with a mass affect suggestive of herniation. The patient was placed on a ventilator and was admitted to the neuro ICU. He was treated with supportive measures. The patient remained comatose and continued to only have occasional spontaneous respirations when tried off the ventilator. The patient expired on the morning of August 21st, 3 days after his admission. ---- In this case it was thought that massive hypertensive hemorrhage in the basal ganglia resulted in uncal herniation with Duret hemorrhages and with compression of the PCA.
