Table of Contents
Washington University Experience | VASCULAR | Infarct - Remote | 2A0 Case 2 History
Case 2 History ---- The patient was a 68-year-old man with a history of left MCA infarction in 1985 (18 years prior to death), epilepsy treated with Dilantin and carbamazepine and mild dementia. Following a day during which he was described as fatigued and confused, he presented to the BJH ER after being found unresponsive by his family with evidence of vomiting. In the ER, he was thought to possibly be post-ictal from an un-witnessed seizure. On further exam, he had increased tone on the right. A head CT showed an old left MCA infarct with encephalomalacia and ex vacuo dilation of the left lateral ventricle. He was hypotensive while in the ER, and later was found by his nurse apneic and pulseless after having been alerted to a change in status by his family. He was intubated, given epinephrine, atropine, and chest compressions and transferred to the ICU, where he developed metabolic acidosis, coagulopathy, evidence of a new MI, and acute renal failure. An abdominal CT showed intestinal pneumatosis consistent with bowel ischemia. His code status was switched to comfort care measures only, and he expired.
