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Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 1A0 Case 1 History
Case 1 History ---- The patient was an 82 year old woman who was residing in a nursing home following a stroke several years prior. Her PMHx includes cholecystectomy, hysterectomy, hip pinning and cataract surgery. Over the past 3 years at the nursing home, she had falling spells. She was in her normal state of health; however, until approximately 3 days prior to this admission when her speech seemed particular rambling and confused; she became lethargic and fell asleep frequently. On the morning of admission she fell, striking the right side of her forehead, and sustained a large scalp contusion. She was found stuporous on the floor and brought to the ER. Blood pressure was 190/100, respirations were 20 and of Cheyne-Stokes type. There was a grade IV/VI systolic murmur at the apex. Although her eyes were open, she was unresponsive to all stimuli except pain. She looked conjugately towards her left, although extraocular movements were intact. There was a decreased right corneal and a right central facial palsy. The right arm was flaccid. The legs withdrew to pain, the right leg less well than the left. Babinski's reflexes were positive bilaterally. CT scan showed a massive left cerebral hematoma extending from the frontal to the occipital poles with considerable left to right shift. There was also a smaller right occipital intraparenchymal hematoma. She remained comatose and unresponsive for the next 6 days and died. ---- Autopsy showed congophilic angiopathy with numerous senile plaques and tangles (AD diagnosed by Khachaturian criteria, 40+ years ago). A massive parenchymal hemorrhage involved the left frontal lobe white matter and smaller hemorrhages involved the right and left occipital lobes. Microinfarcts were widespread and involved cerebellum, hippocampus, right and left frontal lobes. There was bilateral uncal and cingulate gyrus herniation.
