Table of Contents
Washington University Experience | VASCULAR | Infarct - Venous | 1A0 Case 1 History
Case 1 History ---- The patient was a 35 year old, G2P1 woman with a prior history of pre-eclampsia during pregnancy. She was 12 weeks pregnant when she presented to an outside hospital on September 11 speaking incomprehensibly. Prior to this presentation, the patient had been complaining of headache, nausea and vomiting for several days. A CT scan at an OSH was suspicious for cerebral venous thrombosis and evolving hydrocephalus. The patient was transferred to BJH and admitted to the Neurologic ICU for anticoagulation. The patient's symptoms worsened, and repeat CT scans revealed worsening hydrocephalus. The patient's anticoagulation was stopped and an external ventricular drain was placed. On September 13, her exam worsened and repeat imaging revealed further hemorrhage. The patient's poor prognosis was communicated to the family, and her status was designated as "do not resuscitate." The patient continued to have increased intracranial pressure and exams continued to worsen despite being placed on mannitol with hypertonic saline. On the afternoon of September 14 after formal brain death testing, she expired. ---- Autopsy revealed the weight of the unfixed brain was 1340 g and was swollen with effacement of the cerebral sulci. Although the superior sagittal sinus was patent, the internal cerebral veins and straight sinus showed firm, adherent clot extending for several centimeters. The leptomeningeal veins also showed distension and engorgement. Coronal sections revealed massive hemorrhagic infarction of midline structures including bilateral basal ganglia and thalami; left frontal lobe, midbrain and pons. Sections of the internal cerebral veins and straight sinus showed extensive thrombus.
