Autopsy No.: #46758

Case No: 26. Autopsy No.: #46758 Age (decades): 70 Sex: F Decade of Autopsy: 1990 Key Number: 810547 appendectomy ;. hysterectomy ;. bladder repair ;. osteoarthritis ;. family history cerebrovascular accident cancer ;. tick bite ;. onset nausea ataxia right facial weakness ;. admission local ;. diagnosis LYME disease nervous system ;. elevated serum cerebrospinal fluid igm igg titers borrelia burgdorferi ;. intravenous ceftriaxone ;. transfer progression cranial nerve deficits ;. lyme disease ;. secondary bell palsy cerebellar involvement ;. right lid lag ;. heberdeen nodules ;. elevated serum cholesterol ;. aspiration pneumonia ;. pleocytosis ;. mononuclear per lumbar puncture ;. area increased signal ;. weighting noted right cerebellar peduncle ;. enhanced ;. gadolinium ;. white matter lesions corona radiata per magnetic resonance imaging ;. multiple temperature spikes ;. enterobacter species per sputum culture ;. broad spectrum antibiotics ;. right vocal cord paralysis per nasopharyngeal endoscopy ;. acute respiratory arrest ;. intubation ;. extubation required one hour ;. chest radiograph consistent ;. new bilateral aspiration pneumonia ;. admission stereotatic biopsy pontine lesion ;. left gaze paresis anisocoria right cornea decreased sensation bell palsy uvula deviated right ataxia upper extremities ;. consistent ;. right pontine lesion ;. blot negative lymph disease ;. negative rheumatoid factor ;. serum rapid plasma reagin positive ;. broad spectrum antibiotics ;. pulmonary infiltrates per chest radiograph ;. anemia ;. small left pleural effusion sonography ;. atelectasis pleural effusion negative lymphadenopathy negative definite masses per computerized tomography ;. extensive necrosis ;. lymphocytes atypical poorly preserved suggestive negative diagnostic small cell malignant neoplasm per nervous system sterotactic needle aspiration ;. necrotic tissue cannot determine specimen represents necrotic brain abscess tumor per pons needle biopsy ;. steroid therapy ;. tracheostomy ;. mechanical ventilation ;. hypotensive episode responsive fluid resuscitation ;. feeding tube ;. heme positive loose stools ;. conjunctivitis treated ;. topical gentamicin ;. right gaze palsy ;. leukocytosis ;. percutaneous endoscopic gastrostomy tube placement ;. elevated cerebrospinal fluid glucose per lumbar puncture ;. extremely atypical ;. background mononuclear per cerebrospinal fluid analysis ;. left subclavian venous line ;. hypotensive episode responsive fluid resuscitation ;. increasing bilateral atelectasis versus infiltrates per chest radiography ;. antibiotic therapy ;. enterobacter per sputum culture ;. stable ring enhancing lesions posterior pons decreasing cortical edema exam less distortion fourth ventricle per magnetic resonance imaging study ;. diarrhea ;. positive assay clostridium difficile toxin ;. weaning ventilator ;. pulmonary toilet ;. supraventricular tachycardia per electrocardiogram responsive verapamil ;. recurrent atelectasis left lower lobe per chest radiograph ;. continuous positive airway pressure maintain airway ;. empiric flagyl ;. right subclavian line ;. maltophilia per sputum culture enterobacter ;. enterococcus ;. per urine culture ;. cardiopulmonary arrest ;. successful cardiopulmonary resuscitation ;. coma score ;. neurological exam consistent ;. brain death ;. heparin ;. lidocaine pressor agents ;. atrial tachycardia ;. intermittent atrial flutter fibrillation per electrocardiogram ;. increased arterial alveolar oxygen gradient ;. burst suppression pattern consistent ;. severe anoxic brain injury per electroencephalogram ;. negative resuscitate status ;. death ;. well differentiated primary cns lymphoma ;. associated hemorrhage necrosis right inferior cerebellar peduncle brain ;. severe ischemic ;. anoxic ;. encephalopathy cerebral cortex cerebellum brain ;. lacunar infarcts midbrain putamen brain ;. adenoma right kidney ;. acute chronic pancreatitis pancreas ;. chronic passive congestion intrahepatic cholestasis steatosis liver ;. organizing pneumonia right left lower lobes lung ;. focal active pneumonitis lungs ;. scattered cytomegalovirus intranuclear inclusions ;. organized thromboemboli lung ;. leiomyomas stomach esophagus ;. congestion edema lungs ;. weight gms ;. calcified granulomas ;. greatest diameter ;. lower lobe left lung ;. mild atherosclerosis left anterior descending right coronary arteries heart ;. cardiomegaly ;. left ventricular hypertrophy heart ;. fatty infiltration right ventricle heart ;. atherosclerotic plaque ;. stenosis superior mesenteric artery ;. moderate complicated atherosclerosis aorta ;. mild atherosclerosis pulmonary artery ;. degenerative joint disease vertebra ;. hemorrhagic urethritis cystitis urinary bladder ;. hematomas rib fractures anterior chest wall thorax ;. cardiopulmonary resuscitation ;. ulcer gastroesophageal junction ;. cytomegalovirus inclusions underlying endothelium ;. diverticulosis colon ;. tracheostomy tube trachea ;. heberdeen nodes nodes radial deviation distal interphalangeal phalanges hands ;. mild pedal edema ;. surgical absence uterus ovaries ;. hysterectomy