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Washington University Experience | VASCULAR | Small Vessel Disease | 4A0 Case 4 History
Case 4 History ---- The patient was a 61-year-old man with a history of non-ischemic cardiomyopathy, ejection fraction approximately 20%, severe mitral regurgitation, pulmonary hypertension, systemic hypertension, diabetes, chronic kidney disease, status post Bi-V ICD who presented with worsening congestive heart failure exacerbation. Orthotopic heart transplantation was considered but no suitable donor was available and, instead, an implantation of a LVAD was performed as a bridge to transplant. Postoperatively the patient developed persistent leukocytosis and deep vein thrombosis and an echocardiogram in follow-up revealed that the device was not working adequately and it was replaced. He was discharged on 6/25 on Coumadin anticoagulation but developed lower extremity weakness. Head CT showed a new subacute right occipital infarct, an old right cerebral hemisphere watershed infarct and a right cerebellar infarct. Two months later he patient felt dizzy and then became unresponsive in the bathroom, was admitted with ongoing CPR, was stabilized but following a subsequent arrest could not be resuscitated. ---- At autopsy the weight of the unfixed brain was 1130g. There was a subacute hemorrhagic infarct involving right occipital lobe and subacute and remote infarcts involving ACA/MCA territories and cerebellum. Hyaline arteriolosclerosis was moderate to marked.
