A 68-year-old woman presented with chest pain followed by lo
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A 68-year-old woman presented with chest pain followed by loss of consciousness to the emergency department. She was on treatment for hypertension and dyslipidemia. She had a history of myocardial infarction 6 years prior. Vitals on admission showed blood pressure of 80/62 mm Hg, pulse rate of 120 beats per minute and blood oxygen saturation of 85% on room air. ECG was suggestive of anterior wall MI. She was intubated and put on ventilator support. Vasopressor drugs were administered to maintain systolic blood pressure at adequate levels. MRI of the brain after stabilizing the patient showed T2 hyperintensities involving the cortical and deep grey matter structures with reduced diffusivity on diffusion-weighted imaging. The distribution of signal abnormalities to gray matter structures of the brain was suggestive of hypoxic brain injury. She underwent stenting of left main coronary artery for a high-grade stenosis. She was discharged after 10 days. At the time of discharge, she was alert and oriented with no neurological deficits. Three weeks after discharge, she developed complaints of drowsiness, frequent falls, behavioral changes, and urinary incontinence. She developed memory deficits and was having difficulty in remembering the name of family members. The symptoms gradually progressed to complete unresponsiveness over a duration of 3 months.

Following multiple episodes of seizures which required hospital admission, an MRI of brain was requested. MRI revealed marked T2 hyperintensity of the supratentorial white matter with severe generalized cerebral atrophy in comparison to the scan done 4 months prior. T1-weighted images of brain revealed loss of normal T1 signal of the supratentorial white matter in addition to volume loss. She was discharged to a hospice facility and was followed up on outpatient basis. No significant improvement in sensorium or motor functions was noted till her last follow-up visit 5 months after discharge.