1. Clinical Pathology Conference
May 21, Jody Manners, PGY4

2. Clinical History
50 year old female with history of EtOH abuse, NHL s/p R-CHOP 2005, headaches, transferred with AMS.
LSW 6pm on 4/28, presented to OSH after found at 2pm on 4/29 “unresponsive” and with agonal breathing
At OSH, emesis and aspiration and eventually intubated on arrival in Presby ED

3. Additional History PMH: EtOH abuse, NHL s/p R-CHOP 2005, headaches
PSH: Hysterectomy
Home meds: lorazepam, metoprolol
ROS: per family, several days of severe HA

4. Exam OSH: At PUH: Hypothermic, reported fixed pupils
HR 76, BP 162/100, RR 24, T 29.5
Intubated without sedation, 4/4 TOF
Pupils 6mm fixed, symmetric.
+R corneal, no cough, +gag
Extension in all extremities

5. Labs Na 131, BUN/Cr 6/0.3, glucose 115 WBC 8, Hb 15, plt 251
Lactate 3.2
CPK 1029
Trop < > 0.37
EtOH 35

6. Imaging 4/29/18

7. Imaging Final Read
Large R SDH, 1.8cm subfalcine herniation, brainstem duret hemorrhage + IVE in 4th, early/subacute R PCA infarct involving parietal/posterior mesial temporal and entrapment of R temporal horn and left lateral ventricle

8. Hospital Course
NRSGY evaluation in the ED; no intervention and suspected poor prognosis.
Admitted to 4G where expected progression to brain death would occur.
Slowly rewarmed with monitoring of electrolytes, pressor support
Family focus on comfort on 4/29-4/30
CTB 4/30

9. Autopsy Findings:
Severe calcific atherosclerotic cardiovascular disease, up to 95% occlusion of proximal LAD, healed posterior LV infarct, cardiomegaly (440g) and LVH
Bronchopneumonia
Hepatomegaly with steatosis (suspected related to EtOH abuse)
Horseshoe kidney joined at lower poles with focal cortical hemorrhage, with incidental focus of renal cell carcinoma (grade 2, clear cell type favored)
No evidence of lymphoma

10. Gross Examination of Brain
Expected Gross findings
Suspected etiology?