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Washington University Experience | VASCULAR | Infarct - Lacunar | 1A0 Case 1 History
Case 1 History ---- The patient was a 74-year-old woman with a history of hypertension, diabetes mellitus, prior strokes with gastric tube dependency, chronic respiratory failure with ventilator dependency and tracheostomy. Her neurologic baseline was described as "does not regard, does not talk or follow commands, and does not move." Her daughter was concerned about a change in mental status and the patient had witnessed episodes of rightward gaze deviation, nystagmus, and generalized convulsions. She was transferred to the BJH neurological ICU. An MRI was read as consistent with diffuse hypoxic ischemic brain injury. Over the course of the next eight days her neurologic exam did not improve, and she began to decline from a multi-organ systems standpoint and the patient passed away. ---- At autopsy the weight of the unfixed brain was 885 gm. A large left parieto-occipital infarct accounts for much of the loss of brain weight in the absence of neurodegenerative disease. Subacute and remote infarcts involved the hemispheres, deep gray, pons and cerebellum with severe atherosclerosis and arteriolosclerosis.
