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Washington University Experience | VASCULAR | Infarct - Venous | 11A0 Case 11 History
Case 11 History ---- The patient was a 12 yo male with a past medical history of chronic constipation, depression and ADHD who presented to an OSH with a two week history of increasing shortness of breath. A work up there revealed a right lower lobe pulmonary infiltrate and progressive respiratory failure. He was transferred to SLCH on 2/18 for further care. ECMO was initiated on 2/21 and discontinued on 3/1 in the context of multiorgan failure including renal dysfunction treated with continuous veno-venous hemodialysis. Dialysis was discontinued secondary to multiple filter clots and hypertension. In an attempt to reinitiate dialysis a left internal jugular catheter was placed on 3/14. That evening, he became acutely comatose. A HCT was normal but a subsequent MRI revealed bilateral diffuse cortical infarcts. A tracheostomy and g-tube were placed on 3/23. A repeat CT on 3/29 revealed a clot in the left internal jugular vein. On 3/31 he was found to be apneic in asystole and was pronounced dead. ---- Autopsy demonstrated a fresh brain weight of 1500g which showed extensive venous thrombosis involving the superior sagittal, transverse and straight sinuses resulting in extensive subacute infarction of the cerebrum, cerebellum and right basal ganglia with superimposed edema and bilateral tonsillar herniation. Presence of extensive cerebral venous thrombosis suggests the possibility of altered coagulability in this patient.
