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Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 7A0 Case 7 History
Case 7 History ---- The patient was a 73 year old man with a history of coronary artery disease status post CABG x four vessels (2005), hypertension, ischemic cardiomyopathy, type 2 diabetes, peripheral vascular disease, chronic kidney disease, pneumonia and dementia. The patient also had a medical history significant for smoking and alcohol consumption. On 7/3 he had a witnessed syncopal event with associated tonic clonic jerks and urinary incontinence. He was found to be in ventricular tachycardia by EMS, and was cardioverted, and intubated. He was diagnosed with a non-STEMI and treated (including heparin drip). His arrhythmia diagnosis was revised to an atrial fibrillation with aberrancy (causing a wide complex arrhythmia). He was extubated after three days but was noted to have persistent altered mental status. A head CT at that time showed a hemorrhagic infarct in the right MCA territory. He was eventually transitioned to comfort care only and was found pulseless on 7/18. ---- At autopsy the weight of the unfixed brain was 1310 g and appeared edematous. Coronal sections of the cerebral hemispheres showed a large (~9 x 8 x 5 cm) recent hemorrhagic infarct in the right MCA territory involving the parietal, temporal, and occipital lobes. There was subfalcine herniation of right cingulate gyrus and a suggestion of right uncal herniation.
