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Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 12A0 Case 12 History
Case 12 History ---- The patient was an 82 year old man with a history of hypertension who was found unresponsive after an unwitnessed fall from his porch on June 13. No clear seizure activity was observed by his family. On admission to the BJH ED, the vital signs showed a pulse of 80, respiratory rate 20, and blood pressure 170/100. Physical examination revealed a dense left hemiparesis. Head CT showed a massive hemorrhage occupying the centrum semi-ovale of the right cerebral hemisphere, and extending into the cortex of the higher convexity of the anterior parietal region. The patient initially presented with a Glasgow coma scale score (GCS) of 13; and 7 in the Neurosurgical ICU. An intracranial pressure monitor was placed, which was passed to a depth of 4.9 cm, at which point the cranial pressure was 20 cm of water. After that, the patient remained hemodynamically stable on full support, but lacked any neurologic improvement. Finally, the family decided to withdraw the ventilating life support, and the patient was pronounced dead 6 days after admission. ---- At autopsy there was a large hemorrhagic area with softening in the right frontal parietal lobe and measured 8x7x7 cm in greatest dimension. Subfalcine herniation (right to left) with marked softening of the cingulate gyrus was evident as well. Microscopic examination showed profound CAA with numerous microinfarcts
