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Washington University Experience | VASCULAR | Infarct - Lacunar | 4A0 Case 4 History
Case 4 History ---- The patient was a 74 year old woman with a clinical history of diabetes mellitus type II, end stage renal disease (on hemodialysis), coronary artery disease, retinopathy, neuropathy and history of breast and colon cancer. The patient was sent to the ED from her dialysis center on July 2 for decreased heart rate, pallor, weakness, and dyspnea. She was found to have congestive heart failure (volume overload), a non-Q wave MI, and ORSA bacteremia. Within two days of admission, the patient experienced episodes of hypotension. She also was found to have clostridium difficile in the stool, a left atrial thrombus, and hospital acquired pneumonia. The patient's mental status fluctuated with overall decline during her hospital course. On July 25th she became hypotensive, was intubated and sent to the ICU. The patient tolerated hemodialysis poorly from this point on and had declining mental status. She had renal failure, respiratory failure, congestive heart failure, and persistent hypotension. On August 17 ventilatory support was withdrawn and the patient expired. ---- At autopsy, the patient had significant hypertensive and diabetic renal disease with acute and remote myocardial infarcts. The brain weight was 1080 grams with Alzheimer disease as well as acute, severe ischemic changes which were seen in the thalamus, midbrain, pons, medulla, and cerebellum.
