Table of Contents
Washington University Experience | NEURODEGENERATION | Lewy Body Disease (LBD) | 6 LBD - Microscopic Pathology - Cerebral Cortex | 13A0 Case 13 History
Case 13 History ---- At age 71 this male developed memory problems including becoming confused while driving. At age 72, he became slower and developed generalized bradykinesia; then, at age 73, he progressed to having masked facies and a shuffling gait. He also had a progressive decline in memory and could not follow or fully participate in conversations. At age 74 he started to develop right hand tremor and his handwriting became smaller. At age 75 he began having intermittent hallucinations (after starting Requip). Initial evaluation in the movement disorders center at age 75 (in 2010) revealed stage 2 parkinsonism which was rather symmetric. His MMSE at that time was 24/30. He also had an MRI of the brain which revealed an old small left temporal lobe infarct. Over the course of the next year his parkinsonism remained relatively stable but his memory continued to decline. Hallucinations were improved with the addition of Seroquel. The most likely diagnosis was diffuse Lewy body disease with an additional history of a temporal infarct. He was admitted to Barnes in July 2011 with delirium in the setting of dehydration and decreased oral intake. MRI taken at that time showed he had a subacute occipital infarct that temporally correlated with his decline. At this time the family decided to enter him into hospice and withdraw care in accordance with his wishes.
