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Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 5A0 Case 5 History
Case 5 History ---- This was a 67 year old man with a history of myocardial infarction and congestive heart failure in the past who suddenly collapsed while working at home. He was admitted to his local hospital with left hemiparesis, able to say “yes” and "no" and initially was responsive. Over the next day he deteriorated to a comatose state with Cheyne Stokes respirations and periods of apnea. He was sent to the BJH ER where he was intubated. CT scan revealed a large hemorrhagic infarct in the distribution of the right middle cerebral artery. The ventricular system was shifted to the left with almost complete obliteration of the right lateral ventricle and dilatation of the left lateral ventricle. He was able to open his eyes briefly to command and to regard the examiner and to withdraw his right upper and lower extremities. His pupils were 2.5mm on the right, and 2 mm on the left and unreactive to light; external ocular movements were preserved and there was a left central facial palsy. He had a dense left hemiparesis with upgoing toe on the left side and symmetric 2+ reflexes bilaterally. In the Neuro ICU he received 10 mgs of Decadron, was fluid restricted, and observed. Over the next 4 days he gradually improved to where he was able to take small sips of water. His pulse was 50 and vital signs were stable. On the 5th day after onset of his symptoms the patient was found with no spontaneous respirations and idioventricular rhythm. Resuscitation efforts were unsuccessful. ---- Autopsy showed a brain weighing 1480g. A hemorrhagic infarct in the territory of the right middle cerebral artery was not accompanied by a residual thrombus.
