A 58-year-old homeless man is brought to the emergency department after being found unresponsive on a sidewalk. The patient has been hospitalized on several occasions for alcohol and illicit drug intoxication. He also has a history of hypertension but is not adherent with medical therapy. On arrival, the patient is obtunded, febrile, and hypotensive. Despite appropriate intervention, the patient dies. Autopsy reveals extensive atherosclerotic disease involving the coronary and internal carotid arteries. Histopathologic examination of the brain shows neurons with intensely eosinophilic cytoplasm and nuclear fragmentation. Based on these findings, this patient's cerebral injury most likely occurred approximately how long ago?

Question

A 58-year-old homeless man is brought to the emergency department after being found unresponsive on a sidewalk. The patient has been hospitalized on several occasions for alcohol and illicit drug intoxication. He also has a history of hypertension but is not adherent with medical therapy. On arrival, the patient is obtunded, febrile, and hypotensive. Despite appropriate intervention, the patient dies. Autopsy reveals extensive atherosclerotic disease involving the coronary and internal carotid arteries.  Histopathologic examination of the brain shows neurons with intensely eosinophilic cytoplasm and nuclear fragmentation.  Based on these findings, this patient's cerebral injury most likely occurred approximately how long ago?

Quizplus · Accepted Answer

Eductional Objective: Inadequate blood supply to the brain (eg, arterial thrombosis or embolism) leads to ischemic stroke.  The first microscopic changes are typically seen 12-24 hours after irreversible ischemic injury and include intense eosinophilic staining of the neuronal cytoplasm (red neurons) and nuclear fragmentation.

A 58-Year-Old Homeless Man Is Brought to the Emergency Department