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Washington University Experience | VASCULAR | Infarct - Remote | 14A0 Case 14 History
Case 14 History ---- The patient was a 65-year-old man with past medical history of chronic untreated hypertension, ischemic stroke years prior with no residua, polysubstance abuse of cocaine, crack, and alcohol, who presented to the emergency department with a one-day history of right temporal headache. He was noted to have right gaze preference, anisocoria (R<L), right ptosis, truncal instability to the right, hoarseness and dysphagia. Troponins were negative. Head CT was performed and was consistent with stable encephalomalacia secondary to previous infarcts, as well as chronic small vessel ischemia. Brain MRI revealed an acute right pontine infarct, chronic left occipital infarct, diffuse periventricular leukoencephalopathy, and age-related atrophy. The patient was later found in his room unresponsive and bradycardic. During intubation, pulse was noted to be absent, and cardiopulmonary resuscitation was initiated. The patient had a total of 7 cycles of CPR and was cardioverted 4 times for ventricular fibrillation. After approximately 25 minutes of advanced cardiac life support resuscitation, the patient continued to be in ventricular fibrillation arrest. The patient was declared dead. ---- Autopsy showed multiple small remote infarcts (demonstrated here) and a subacute infarct involving the lateral medulla.
