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Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 9A0 Case 9 History
Case 9 History ---- The patient was a 72 year-old man with past medical history of diabetes mellitus, coronary artery disease, hypertension and hypercholesterolemia, who presented on January 16 with acute onset of right sided hemiparesis, and aphasia after a fall. Initial head CT was unremarkable. Blood pressure was ~180/95. He had normal platelet, glucose and coagulation parameters. His medications included aspirin and Plavix. He was given tPA with initiation of infusion at ~23:30. During the tPA infusion, his blood pressure rose to 199-208/120-130 but was controlled with Labetelol. After a day of observation in the NICU, he was transferred to the floor. He had no recovery of function and was noted to be less responsive. Over the next few hours he went into respiratory distress, was intubated, and demonstrated signs of brain stem herniation. A head CT this time showed a hemorrhagic infarct. His care was withdrawn and he expired on January 19. ---- At autopsy the weight of the unfixed brain was 1410 gm. There was an acute hemorrhagic left middle cerebral artery infarct with left uncal, cingulate and tonsillar herniation. Prominent atherosclerosis involved basilar and left middle cerebral arteries.
