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== Clinical Summary ==
Eight years prior to his demise, this 48-year-old black male had a dissecting aortic aneurysm. The first portion of the aortic arch was dilated with an associated aortic valve insufficiency. The defect was repaired and a mechanical prosthetic valve was implanted. One year prior to his terminal admission, the patient experienced a catastrophic cerebrovascular accident (CVA) with left hemiparesis and obtundation. The patient experienced severe neurologic sequelae from this CVA and was eventually transferred to a nursing home where he was bedbound and required an indwelling urinary catheter. The patient developed a urinary tract infection and was transferred to the hospital. The patient's condition deteriorated and he died 6 weeks after admission with a urinary tract infection and pneumonia.
== Autopsy Findings ==
Autopsy showed the expected findings in the aorta and in a 760-gram heart. The mechanical valve showed some deterioration and there was old thrombotic material adherent to the valve, which was probably the source of the emboli which caused the patient's CVA. The patient's 1250-gram brain showed extensive old infarctions in at least three different areas, with the largest (12.5 x 5.5 cm) in the distribution of the right middle cerebral artery.
== Images ==
<gallery heights="250px" widths="250px">
File:IPLab3BrainInfarction11.jpg|This is a closer view of the brain demonstrating an old healed infarct with the meninges containing blood vessels (arrow) overlying the infarcted region.
</gallery>
== Study Questions ==
* <spoiler text="What is the most common cause of stroke?">Thrombotic occlusion of cerebral arteries due to atherosclerosis. The carotid arteries, the origin of the middle cerebral artery, and either end of the basilar artery are the most common sites of thrombus.</spoiler>
* <spoiler text="What is the likely cause of stroke in this patient?">Infarction resulting from thrombotic material from the prosthetic heart valve.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/1916852-overview eMedicine Medical Library: Ischemic Stroke]
* [http://emedicine.medscape.com/article/756835-overview eMedicine Medical Library: Acute Aortic Dissection]
* [http://emedicine.medscape.com/article/780702-overview eMedicine Medical Library: Prosthetic Heart Valves]
* [http://www.merckmanuals.com/professional/neurologic_disorders/stroke_cva/overview_of_stroke.html Merck Manual: Overview of Stroke (CVA)]
* [http://www.merckmanuals.com/professional/hematology_and_oncology/thrombotic_disorders/thrombotic_disorders.html Merck Manual: Thrombotic Disorders]
* [http://www.merckmanuals.com/professional/cardiovascular_disorders/diseases_of_the_aorta_and_its_branches/aortic_dissection.html Merck Manual: Aortic Dissection]
=== Journal Articles ===
* Love S, Barber R, Wilcock GK. [http://www.ncbi.nlm.nih.gov/pubmed/10736067 Neuronal death in brain infarcts in man]. ''Neuropathol Appl Neurobiol'' 2000 Feb;26(1):55-66.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/55-brain/30-infarct PEIR Digital Library: Brain Infarct Images]
* [http://library.med.utah.edu/WebPath/CNSHTML/CNSIDX.html#4 WebPath: Brain Infarction]
== Related IPLab Cases ==
* [[IPLab:Lab 8:HSV Encephalitis|Lab 8: Brain: Herpes Encephalitis]]
* [[IPLab:Lab 8:Rabies|Lab 8: Brain: Rabies]]
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[[Category: IPLab:Lab 3]]