CASE HISTORY

Nine days before admission the patient started a pyrexial illness accompanied by progressively increasing headache, vomiting and neck stiffness. He was treated by her family doctor by antibiotics. In spite of this she developed convulsions and was admitted to another hospital. Lumbar puncture was performed and the CSF was sterile. She became oliguric and shortly after this was delivered of a macerated female foetus. She was finally transferred here for dialysis. By this time her blood urea was 435mg and her potassium was 7.1mEq/l. Haemodialysis was carried out but she died the next day. Renal failure was due to tubular necrosis.

PATHOLOGY

The specimen consists of a coronal section of the cerebrum. The meninges are opaque. The meningitis is not otherwise particularly obvious, probably owing to treatment. The vessels are peculiarly prominent and some of them stand out as almost black rods. These are in fact thrombosed and it is this venous thrombosis that has given rise to patchy areas of cerebral infarction which show as irregular granular areas with a rather greyish colour. They are present in both insula, in the left temporo-spenoidal lobe and just to the left of the midline below the septum pellucidum.