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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Binswangers | 3A0 Case 3 History
Case 3 History ---- This patient was a 60 year old man with multiple medical problems. He had congestive heart failure, status epilepticus in March 2008 requiring intubation, multiple prior cerebrovascular accidents, history of dementia, hypertension, diabetes, peripheral vascular disease status-post left femoral shunt, chronic kidney disease with a baseline creatine of approximately 3. He was admitted in May 2008 for tachypnea and mental status changes. He had a witnessed aspiration of his tube feeds en route to the hospital from his nursing home. He was intubated for respiratory failure in the emergency department. The patient was admitted to the medical intensive care unit where after discussion with his family he was made DNR/DNI. He was noted to be in ventricular tachycardia followed by ventricular fibrillation then asystole one week after admission. Autopsy report: The weight of the unfixed brain was 1200 grams. None of the histologic features of Alzheimer disease, Pick Dz, Parkinson Dz, diffuse Lewy body disease (dementia with Lewy bodies), PSP, multiple system degeneration, and corticobasal degeneration were found. Staining for tau protein revealed a few pretangles and a rare neurofibrillary tangle within the section from the hippocampus. The white matter shows multiple areas of ischemic damage ranging from myelin pallor with edema to well-defined remote infarcts. There is severe arteriolosclerosis with thickened sclerotic arteries. Some of the vessels are surrounded by hemosiderin-laden macrophages, suggesting prior hemorrhage. There is no evidence of vasculitis, microthombi, granular deposits, or amyloid deposition within the microvasculature. Sections of the basal ganglia and thalamus demonstrate similar ischemic lesions and microvascular changes. A diagnosis of arteriolosclerosis, severe, with extensive subcortical ischemia ("Binswanger's Disease"; "subcortical arteriolosclerotic encephalopathy") was made.
