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Washington University Experience | VASCULAR | Ulegyria | 11A1 Ulegyria (Case 11) CT 5

Case 11 History ---- The decedent was a 71yo male living in a nursing home with a history of a poorly characterized static encephalopathy with hypertension, and urinary retention status post recent treatment with nitrofurantoin for complicated urinary tract infection who presented to the emergency department in October 2019 with altered mental status and dyspnea. He was found to have hypotension, hypothermia, a lactate level of 1.7, >50 WBC on urinalysis, elevated alkaline phosphatase, and was subsequently admitted for septic shock. He was treated with IV fluid resuscitation, broad-spectrum antibiotics, ampicillin and acyclovir for meningitis/encephalitis coverage, and pressors with Levophed, but was unable to be weaned off due to refractory shock. He was also noted to have an acute kidney injury, believed to be prerenal due to decreased vascular perfusion from septic shock. The patient continued to decline and goals of care were redirected to comfort care only. ---- 11A1-3 Multiple levels of a CT exam at an earlier time reveals marked loss of cerebral cortex with ulegyria, ventricular dilatation and loss involving the corpus callosum.

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