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Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 11A0 Case 11 History
Case 11 History ---- The patient was a 72-year-old woman with a history of hypothyroidism and hyperlipidemia who was transferred to the BJH ED following acute onset of left sided paralysis and loss of consciousness. The patient suddenly began having left-sided numbness and weakness when working in her yard and soon became unresponsive. Taken to an OSH, a brain CT scan showed intraparenchymal hemorrhage and she was transferred to BJH. Head CT performed at BJH showed multiple intracranial areas of cerebral hemispheric hemorrhage in the right and left sided parenchyma with ongoing uncal herniation. Physical examination showed pupils that measured 5 mm, were fixed, and at mid-position. She had no doll's response and no corneal reflexes. She showed extensive posturing to peripheral and central stimulation. Laboratory evaluation showed: INR 1.06, aPTT 21.7 s, WBC=15.9 K/mm3, hemoglobin 11.5 g/dL, hematocrit 33.9%, platelet count 216 K/mm3. The family decided to redirect care. Her neurologic status continued to deteriorate and she was pronounced dead after hospitalization of less than 24 hours. ---- At autopsy the weight of the unfixed brain is 1360 g. In addition to severe CAA, the brain shows evidence of very mild Alzheimer Disease Neuropathologic Change. There was right frontoparietal lobar hemorrhage with extension into the left hemisphere. This induced subfalcine, uncal and tonsillar herniation that resulted in hemorrhagic infarcts of the right anterior cingulate and bilateral posterior cerebral artery territories as well as inducing Duret hemorrhage in the brainstem.
