Table of Contents
Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 15A0 Case 15 History
Case 15 History ---- This 67 year old right handed man was initially transferred to BH on 1/91 for treatment of bilateral pneumonia and septic shock. He was reportedly in good health until November 1980. On November 30 he developed a herpes zoster rash over his right chest, shoulder, and back in the Tl-T2 distribution. Throughout the month of December he suffered severe pain. On January 4, 1981, he was reportedly lethargic and had slurred speech. On 1/7/81, he was found to be arousable only to deep pain. He was noted to be very tachypneic with fever to 105°F, respiratory rate of 50, and blood pressure of only 80/40. An admitting chest x-ray showed bilateral pneumonia. Cultures were obtained. He was treated with steroids, ampicillin, and Tobramycin. He was transferred to BJH, markedly obtunded, unresponsive except to vigorous stimulation. His pupils were miotic and reactive sluggishly to light and he had abnormal brainstem reflexes. On 1/19, a blood culture was positive for yeast. He was started on treatment with amphotericin B. He continued to be unresponsive. On 1/25/81 he showed progressive hypotension and hypoxemia. He was pronounced dead on 1/25. ---- At autopsy, there is a focal area of non-hemorrhagic infarction in the left temporo-parietal region in the distribution of the left middle cerebral artery. In the occipital lobes, there are bilateral recent hemorrhagic infarcts in the distribution of the posterior cerebral arteries without brainstem Duret infarcts or definitive uncal herniation. The microscopic appearance of both infarcts is consistent with only a one-to-two day duration. This may represent emboli or infarction with transient uncal herniation.
