Table of Contents
Washington University Experience | VASCULAR | Respirator Brain (In Vivo Autolysis) | 1A0 Case 1 History
Case 1 History ---- The patient was a 45 year-old woman, s/p lumbar decompression laminectomy for low back pain (12/5) without complications. Her past medical history was significant for depression, alcohol abuse, diabetes mellitus type 2 and hypertension. She was admitted after being found down at home on 12/7. She had been sleeping, mumbled briefly, and then was unresponsive for 15 minutes. EMS took her to an outside hospital and she was resuscitated after an additional 15 minutes of asystole. A recently-filled bottle of Darvocet had 25 missing pills. She was given Narcan without effect. Initial exam showed no evidence of brainstem activity. Laboratory tests were significant for K+ 6.7, CO2 13, Creatinine 1.9, WBC 21,800 (91% neutrophils), Hgb 8.7, ABG 7.24/34/264. Her urine screened positive for benzodiazepines and tricyclic antidepressants (verified to be within therapeutic range), but negative for acetaminophen or salicylates. Head CT scan showed diffuse cerebral edema with evidence of herniation. Liver needle biopsy showed microvesicular fatty changes, involving 40% of parenchyma; she was not a potential organ donor. Life support was withdrawn on 12/10. ---- Autopsy findings included severe generalized cerebral edema and hypoxia/ischemia, uncal and tonsillar herniation, subarachnoid hemorrhage and fragments of necrotic cerebellum involving the lumbar subarachnoid space. In this case the autolytic change involved the tonsillar cerebellum which was tightly compacted into the foramen magnum and likely failed continued perfusion with resultant autolysis.
