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Washington University Experience | VASCULAR | Small Vessel Disease | 18A0 Case 18 History
Case 18 History ---- The decedent was a 62-year-old female with stage 5 chronic kidney disease on dialysis, poorly controlled hypertension, diastolic heart failure, and COPD who was found unresponsive in her nursing home on 08/02. She was brought to an OSH where a head CT showed a 1.7 cm thick left acute subdural hematoma with approximately 1.8 cm midline shift and acute hemorrhage in the posterior pons. The patient was put on a ventilator, administered mannitol and transferred to BJH for further management. On arrival, she was nonresponsive, had bilateral fixed pupils, had a weak corneal reflex on the right, had a cough and gag reflex, weakly extended bilateral upper extremities, and triple flexed bilateral lower extremities. After discussing the clinical situation with her brother it was decided to forgo surgical evacuation of the hematoma due to the low probability that the patient would make a functional recovery without significant comorbidities, a wish that the patient had previously communicated. The patient was extubated with family at the bedside and expired on 08/02. ---- At autopsy the weight of the unfixed brain (with subdural hematoma) was 1240g. There was left subdural and subarachnoid hemorrhage with uncal herniation, prominently left sided, and arteriolosclerosis involving subcortical white matter.
