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Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 21A0 Case 21 History
Case 21 History ---- The patient was an 86 year old right handed woman who had a history of intermittent episodes of numbness involving the left arm, face, and leg. Seen by Neurology, her exam was unremarkable; however a CT scan showed multiple lucencies in the right hemisphere. She was treated with aspirin and Persantine and had an unremarkable course. On the day of admission the patient was known to be well at 1400 hours but did not answer a call 5 hours later. Her daughter found the patient lying unresponsive. Her BP was 180/90, pulse of 80 and regular rhythm without fever. The pupils were 2.5, round, and reactive to light. There was no evidence of external head trauma. Her heart had a grade 3/6 systolic murmur. She lay quietly in bed few spontaneous semi-purposeful movements of the right upper extremity. Cranial nerves and motor exam were normal. On sensory exam, the patient reacted to deep pain bilaterally and localized deep pain on the right side. Reflexes were 2 symmetric with bilateral extensor plantar reflexes. An EMI (old MRI-type scanner) scan showed intraventricular blood and diffuse intracerebral hematoma over most of the right hemisphere. Protime was 100%, PTT was 24.3 sec, platelet count was 250,000. Within a few hours, the patient was totally unresponsive to any stimuli with decerebrate posturing, right greater than left. The right pupil was 1 to 2 mm larger than the left. There were no vertical doll's eye movements. The patient's condition remained essentially unchanged over the next 10 days. The patient also became febrile on the 6th hospital day and was found dead by the nursing staff. ---- An autopsy showed a large acute intracerebral hemorrhage of the right frontal and parietal lobes with subarachnoid and subdural hemorrhage over the right fronto-parietal cortex as well as a remote cystic infarct of the right frontal lobe at the level of the superior frontal gyrus and hippocampus.
