Table of Contents
Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 3 LBD - Gross Pathology - Pallidotomy and DBS | 7B Case 7 Denouement
No neuritic plaques or neurofibrillary tangles are seen in Bielschowsky stained sections of neocortex. However, numerous neurofibrillary tangles are found in the CA1 region of hippocampus and entorhinal cortex, with lesser degrees of involvement in the amygdala. Occasional neuritic plaques are found in these mesial temporal structures. Scattered Lewy bodies are found in multiple sections of neocortex and subcortical nuclei, including the cingulate gyrus, nucleus basalis, and amygdala. Sections of the midbrain demonstrate marked neuronal loss and gliosis in the substantia nigra and locus ceruleus. Rare Lewy bodies are seen. ---- Neuro Final Diagnosis: Cortical (diffuse) Lewy body disease; Alzheimer Disease Neuropathologic Change (ADNC) low; Organizing right thalamotomy site ---- Neuro Diagnosis Comment: The autopsy findings are unusual in that the Alzheimer's type pathology consisted almost exclusively of neurofibrillary tangles and were confined to mesial temporal structures (A modern diagnosis likely would be "PART"). No neocortical Alzheimer's type changes were identified. An additional explanation for this patient's eventual dementia was the presence of diffuse Lewy body disease, which accompanied the expected nigral pathology.
