title: [A 93-year-old woman presenting consciousness disturbance, left hemiplegia, and respiratory distress].
abstract: We present a 93-year old female who abruptly developed left hemiplegia on the way to the wash room. She was admitted to another hospital where her consciousness deteriorated and artificial respiration was necessary. She was transferred to our hospital 20 days after the onset of her stroke. On admission, her BP was 60/40 mmHg, and wheezing râle was heard in both lung fields. No heart murmur was present. She was in comatose state, but a small amount of spontaneous movements were present in her eyelids and the jaw. Neurologic examination revealed no papilledema, small non-reactive pupils with the right side being slightly larger than the left, absence of ocular movements, and loss of oculocephalic response and corneal reflex. An intratracheal tube was in situ, and the observation of the pharynx was impossible. No stiff neck was present. No spontaneous movement was observed in her limbs which were flaccid, and all the deep reflexes were lost except for jaw jerk which was weakly positive. Cranial CT scans revealed low density areas in the right anterior and middle cerebral artery territories with patchy areas of high density being consistent with a hemorrhagic infarction. In addition, a small high density mass lesion was noted in the left frontal lobe adjacent to the falx, which was thought to be a small meningioma. Her clinical course was complicated by pneumonia, hypotension and cardiac failure. She expired 2 months after the onset of her stroke. Postmortem examination revealed an extensive hemorrhagic infarction involving the territory of the right internal carotid artery.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Miwa
authors.forename: N
authors.initials: N
authors.lastname: Imamura
authors.forename: Y
authors.initials: Y
authors.lastname: Mizutani
authors.forename: H
authors.initials: H
authors.lastname: Shiotsu
authors.forename: N
authors.initials: N
authors.lastname: Kuwabara
authors.forename: M
authors.initials: M
authors.lastname: Nagaoka
authors.forename: T
authors.initials: T
authors.lastname: Sato
authors.forename: Y
authors.initials: Y
authors.lastname: Mizuno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology; D003244:Consciousness Disorders / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006429:Hemiplegia / Q000209:etiology*; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000150:complications / Q000473:pathology; D008577:Meningeal Neoplasms / Q000150:complications / Q000473:pathology; D008579:Meningioma / Q000150:complications / Q000473:pathology; D012131:Respiratory Insufficiency / Q000209:etiology*