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Washington University Experience | VASCULAR | Infarct - Venous | 7A0 Case 7 History
Case 7 History ---- This patient was a 4 yo previously healthy girl with a history of 2 weeks of URI with fever and lethargy. She was treated at an OSH ER and recovered two days later. Ten days later on 6/28 she developed headache, vomiting, and loose stools, but did not have fever. On 6/30 after a bath, she was found responding inappropriately with a “glazed” look and vomiting. Head CT showed a left temporo-parietal hemorrhage, left lateral ventricular obliteration and a small midline shift. She was given fosphenytoin, intubated and transferred to SLCH. En route, she developed a fixed, dilated left pupil prompting administration of mannitol and hyperventilation. These were continued at SLCH, and vitamin K and FFP were added for a prothrombin time of 17.0. Broad spectrum antibiotics were also started. Her parents and 8 year-old brother also had similar URI symptoms at that time. EKG and 2D echogram performed at SLCH were normal. Viral (including HSV) and bacterial cultures and PCR of sputum and blood were negative. Later that night she developed decorticate posturing with minimal CNS activity. Repeat head CT showed midline shift and uncal herniation. Serial exams confirmed brain death. ---- At autopsy, the weight of the unfixed brain was 1245 g. The superior sagittal sinus was thrombosed and the thrombus extended into the draining left parietal superficial cortical veins which were engorged and firm to touch. A small amount of right parietal subarachnoid hemorrhage was also present. There is also generalized cerebral edema with effacement of adjacent sulci. Coronal sections of the cerebral hemispheres revealed a hemorrhagic infarct involving left frontal, temporal, parietal and occipital lobes extending from the cortical surface to left lateral ventricle.
