Finding into death of Margaret Ann Day

66y · Female·Ischaemic brainstem stroke

Margaret Ann Day, a 66-year-old Specialist Disability Accommodation resident with undifferentiated hereditary ataxia, intellectual disability, and dysphagia, presented to the Emergency Department on 26 November 2024 with acute focal neurological symptoms. CT imaging revealed bilateral occipital posterior circulation infarcts with basilar artery occlusion, placing her outside the thrombolysis window. She was admitted to the Stroke Unit, commenced on anticoagulation and supportive care including nasogastric feeding. Despite antiepileptic management, she developed progressive seizure activity and clinical deterioration. Repeat imaging revealed extensive brainstem infarction deemed unsurvivable. Palliative care was instituted and she died on 9 December 2024. This case illustrates the challenges of managing extensive acute stroke outside intervention windows in patients with significant comorbidities, and the importance of early advance care planning discussions with family in such circumstances.