26309459 Visualization

A 58 Age - year Age - old Age man Sex with a past medical history of poorly Detailed_description controlled Detailed_description hypertension Disease_disorder and type Disease_disorder 2 Disease_disorder diabetes Disease_disorder , presented Clinical_event to the ICU Nonbiological_location for a cardiogenic Disease_disorder shock Disease_disorder complicating acute Detailed_description myocardial Disease_disorder infarction Disease_disorder .
Physical Diagnostic_procedure examination Diagnostic_procedure revealed reduced Lab_value level Diagnostic_procedure of Diagnostic_procedure consciousness Diagnostic_procedure ( Glasgow Diagnostic_procedure Coma Diagnostic_procedure Scale Diagnostic_procedure 10/15 Lab_value ) and weak Lab_value vital Diagnostic_procedure signs Diagnostic_procedure ; a blood Diagnostic_procedure pressure Diagnostic_procedure of 80/50 Lab_value mmHg Lab_value , 80% Lab_value of oxygen Diagnostic_procedure saturation Diagnostic_procedure , capillary Detailed_description blood Diagnostic_procedure glucose Diagnostic_procedure at 2.26 Lab_value g/L Lab_value , a heart Diagnostic_procedure rate Diagnostic_procedure over Lab_value 125 Lab_value bpm Lab_value , and crackling Sign_symptom in pulmonary Diagnostic_procedure auscultation Diagnostic_procedure .
Cardiovascular Diagnostic_procedure examination Diagnostic_procedure showed neither cardiac Sign_symptom murmur Sign_symptom nor signs Sign_symptom of Sign_symptom right Sign_symptom heart Sign_symptom failure Sign_symptom .
ECG Diagnostic_procedure on admission Clinical_event showed normal Lab_value sinus Detailed_description rhythm Diagnostic_procedure , with heart Diagnostic_procedure rate Diagnostic_procedure of 125 Lab_value bpm Lab_value and extended Sign_symptom ST Sign_symptom - elevation Sign_symptom in anterior Detailed_description territory Detailed_description .
Laboratory Diagnostic_procedure results Diagnostic_procedure demonstrated Troponin Diagnostic_procedure I Diagnostic_procedure level of 6.41 Lab_value ng/ml Lab_value , creatinine Diagnostic_procedure kinase Diagnostic_procedure ( CKMB Diagnostic_procedure ) was 67 Lab_value UI/L Lab_value , Lactate Diagnostic_procedure deshydrogenase Diagnostic_procedure was 281 Lab_value UI/L Lab_value , glucose Diagnostic_procedure level 2.70 Lab_value g/l Lab_value , urea Diagnostic_procedure 0.40 Lab_value g/l Lab_value and creatinine Diagnostic_procedure 18.6 Lab_value mg Lab_value / Lab_value L.
The patient was intubated Therapeutic_procedure and sedated Therapeutic_procedure , inotropic Medication agents Medication were started ( norepinephrine Medication 0.4µg/kg/min Dosage and dobutamine Medication 20µg/kg/min Dosage ).
Chest Biological_structure X Diagnostic_procedure - rays Diagnostic_procedure showed diffuse Detailed_description alveolar Disease_disorder syndrome Disease_disorder .
Transthoracic Biological_structure echocardiography Diagnostic_procedure revealed wall Sign_symptom motion Sign_symptom abnormalities Sign_symptom namely extensive Severity akinesis Sign_symptom of anteroseptal Biological_structure , anterior Biological_structure , lateral Biological_structure and inferior Biological_structure walls Biological_structure , and severe Severity left Sign_symptom ventricular Sign_symptom systolic Sign_symptom dysfunction Sign_symptom ( ejection Diagnostic_procedure fraction Diagnostic_procedure of 29% Lab_value ).
Medical Therapeutic_procedure management Therapeutic_procedure was initiated; anticoagulant Medication therapy for acute Disease_disorder coronary Disease_disorder syndrome Disease_disorder was started ( 500 Dosage mg Dosage of acetylsalicylic Medication acid Medication and subcutaneous Administration low Medication - molecular Medication - weight Medication heparin Medication ( 0.6ml Dosage of enoxaparin Medication )) and patient was prepared for myocardial Therapeutic_procedure revascularization Therapeutic_procedure by coronary Biological_structure angioplasty Therapeutic_procedure .
Because of non Lab_value - improvement Lab_value of neurological Diagnostic_procedure status Diagnostic_procedure and occurrence of seizures Sign_symptom , a brain Biological_structure CT Diagnostic_procedure was indicated and revealed infratentorial Biological_structure diffuse Detailed_description hemorrhage Sign_symptom ( Fisher Diagnostic_procedure grade Diagnostic_procedure III Lab_value ) (Figure 1).
Cerebral Biological_structure angiography Diagnostic_procedure confirmed a dissecting Disease_disorder aneurysm Disease_disorder of an anastomotic Biological_structure branch Biological_structure between left Biological_structure PICA Biological_structure and the V4 Biological_structure segment Biological_structure of Biological_structure left Biological_structure vertebral Biological_structure artery Biological_structure Figure 2 that was successfully embolized Therapeutic_procedure .
After Date 24 Date hours Date , the patient improved Sign_symptom with withdrawal of vasoactive Medication drugs Medication in 24 Date hours Date .
Left Biological_structure hemicorporeal Biological_structure seizures Sign_symptom persisted despite anticonvulsant Medication treatment.
Control brain Biological_structure CT Diagnostic_procedure did not report rebleeding Sign_symptom and angiography Diagnostic_procedure showed complete exclusion of the aneurysm Disease_disorder while the EEG Diagnostic_procedure revealed a diffuse Detailed_description brain Disease_disorder damage Disease_disorder .
10 Date days Date after Date admission, the patient was discharged Clinical_event in stable Lab_value condition Diagnostic_procedure but still suffers from amnesia Disease_disorder .