Case 5 History ---- The patient was an 8 year old female born at 38 weeks gestation with a birthweight of 6 pounds 13 ounces. Her mother was an insulin requiring diabetic 27 years old at the time of birth. Her mother also had bipolar disorder and had smoked throughout the pregnancy. The patient was born via C-section. Her birth was complicated by umbilical cord wrapped tightly around her right arm below the elbow in addition to several loops around the neck. She experienced hypoxia and subsequent perinatal stroke secondary to coagulopathy from the near amputation of her right upper extremity. She was cared for at a state home with cerebral palsy, seizure disorder, asthma, aphasia and cortical blindness. She had a one day history of diarrhea that was non-bloody but without any vomiting. She also had some cough and wheezing. On 2/23, she had a seizure that was composed of right eye nystagmus, forward fixing of left eye and tachycardia. She was given clonazepam and EMS was called. She had a fever of 105 and tested positive for influenza A and group A strep. She had a chest x-ray interpreted as "bronchial thickening with atelectasis, less likely pneumonia, no evidence of focal consolidation." She was weaned on room air on discharge, and was followed by pulmonary/allergy consult and neurology for seizure management. On 6/22, the patient was given a breathing treatment at 4:00 am, followed by breakfast at 5:00 am. When the patient was checked on at 5:40 am, she was not breathing and did not have a pulse. Cardiopulmonary resuscitation was begun immediately and EMS was called. The patient was subsequently rushed to BJ-St. Peter's Hospital where she was intubated, an intravenous line was placed, and further resuscitation was attempted. The attempts were unsuccessful and the patient was declared dead. ---- At autopsy the weight of the unfixed brain is 800g (nl=1273 g),
