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Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 1A0 Case 1 History
Case 1 History ---- The decedent was an 82 year old woman with a past history of Parkinson disease (PD), dementia, depression, hyperlipidemia, hypertension, strokes, and hip fracture. Her symptoms started 6 years prior with posturing of her right hand, bradykinesia, and other movement symptoms which responded partially to DOPA. Her cognitive symptoms included slowed recall, impaired thought process, and forgetfulness. Two years prior to death she suffered a left ischemic infarct in the posterior circulation and received tissue plasminogen activator (tPA) followed by hemorrhagic transformation. After this event, she resided at a long-term care facility. On 7/3 she presented to an OSH with new onset right sided weakness and unresponsiveness. No tPA was given in treating this ischemic process. She was transferred to BJH per family request, where head/brain CT imaging showed a left hemispheric infarct with hemorrhagic transformation, edema and early uncal herniation. She was placed on comfort care and expired on 7/6. ---- At autopsy the unfixed brain weighed 1380g. A recent hemorrhagic infarct involved left frontal, parietal and temporal cortex and left basal ganglia which resulted in transtentorial left uncal and subfalcine cingulate herniation. In addition, a remote (2 years by history) hemorrhagic infarct was found in the left occipital cortex. Findings of dementia with Lewy bodies was the cause of her dementia.
