Case 288 -- A 67 Year Old Man in Coma Requiring Prolonged Mechanical Ventilation

Contributed by Mubarak Al-Gahtany, Kalman Kovacs and Juan M. Bilbao
    University of Toronto Neuropathology, St.Michael's Hospital, Toronto, ON, Canada

Published on line in November 2001


A 67 year old man with a history of type II diabetes mellitus and alcohol abuse complained of back pain of two weeks duration and difficulties in walking. CT scan of the abdomen demonstrated an abdominal aortic aneurysm that was surgically repaired. Postoperatively he developed right foot ischemia requiring urgent thrombectomy complicated by moderate hypotension lasting 45 minutes. Post-thrombectomy he was ventilated and developed rhabdomyolysis and renal failure. Below the knee amputation of the gangrenous right leg became necessary. After the surgery he remained unconscious. CT and MRI of the brain were normal and EEG showed no seizure activity. No endocrine studies were undertaken. He was kept ventilated with full supportive measures. Since no improvement was apparent, he was taken off the ventilator and was pronounced dead two days later, 35 days after leg amputation.

Autopsy performed 37 hours after death revealed severe diffuse atherosclerosis. The myocardium was hypertrophic; the lungs were congested and edematous. The liver weighed 2010 grams and showed evidence of micronodular cirrhosis. The brain weighed 1430 grams and showed slight congestion and softening.



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