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Washington University Experience | VASCULAR | Vasculitis - PACNS | 11A0 Case 11 History
Case 11 History ---- The patient is a 28-year-old woman with multiple medical problems including diabetes mellitus, renal failure, and congestive heart failure. She recently suffered a large left hemispheric stroke. A left frontotemporal craniectomy was performed on 6/17 for decompression and though there was initial improvement, overall, she continued to worsen. Recent CT scan shows gradual enlargement of the right lateral ventricle. This was followed by placement of an external ventricular drain which did not provide improvement. Craniectomy of the left frontoparietal region showed overwhelming cerebral edema with brain herniating from the wound. Partial left temporal and frontal lobectomies were performed. Operative procedure: Left sided hemicraniectomy and hematoma evacuation. ---- The morphological changes present in this tissue represent an early ischemic infarct. The presence of significant collections of acute inflammatory cells and vessels of various levels of integrity is interpreted in this context to represent part of the response to ischemia rather than a primary vasculitis. Underlying hyalinized vessels and those with subintimal damage and expansion likely reflect her systemic disease.
