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Washington University Experience | VASCULAR | Infarct - Lacunar | 5A0 Case 5 History
Case 5 History ---- The patient was a 65 y/o man with diabetes, hypertension and a history of a myocardial infarction in 1978. He was admitted on February 2nd for left hemiparesis. Head CT showed several old lacunar infarcts bilaterally with no new lesions. Carotid Doppler study on 2-7-96 showed less than 50% occlusion of the common carotid but the internal and external carotid arteries were not well visualized due to a high bifurcation. On February 10th he experienced left leg pain and swelling. At this time heparin was also begun. A Doppler study showed no deep venous thrombosis in the lower extremities. After 2/10 there was no further progression of the hemiparesis and on 2/12 there was spontaneous return of some strength in the left upper extremity. The patient did well in rehabilitation without further progression of his symptoms. On February 24 the patient had a witnessed arrest (pulseless/apneic) and despite CPR, he did not respond to resuscitative efforts. ---- The autopsy findings included a large saddle thromboembolus in the pulmonary arteries. The brain weighed 1230 grams. A few tiny remote lacunes were present in the pons; however, but the most relevant finding to his clinical course was the presence of a subacute infarct selectively involving the right pyramid above the level of decussation.
