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Washington University Experience | VASCULAR | Infarct - Remote | 1A0 Case 1 History
Case 1 History ---- The patient was a 73 year old man with a history of coronary artery disease and multiple strokes (first > years ago) who at baseline had dense right hemiparesis with aphasia. Terminally, he became unresponsive with eyes deviated to the right and decerebrate posturing in response to noxious stimulation. His right arm and leg were spastic in tone in comparison to his flaccid left arm. Plantar response was extensor, bilaterally. Head CT on admission revealed a large remote infarct in the distribution of the left MCA and tiny lacunes in the right cerebellum as well as an evolving recent infarct involving the right parieto-occipital lobes. The patient remained unresponsive throughout hospitalization with decerebrate posturing and irregular breathing. Carotid duplex scan revealed a completely occluded left ICA and high grade stenosis of the right ICA. The patient remained comatose, was discharged to hospice, and died one day later, approximately 11 days after the onset of his right parietal stroke.
