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Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 23A0 Case 23 History
Case 23 History ---- The patient was a 79 year old hypertensive man with a history of stroke several years before his death, which resulted in slurred speech and memory problems. On the day of admission, he drove off the road but without any evidence of trauma. He was subsequently transferred to BJH for further management. On neurologic exam he was obtunded without verbal output. On motor exam he had no movements of the left upper or left lower extremities, which withdrew minimally to noxious stimuli. A head CT and MRI revealed a large right frontal high convexity intraparenchymal hemorrhage with surrounding edema and a smaller left fronto-parasagittal hematoma. There was no enhancement following contrast administration. In addition to this lesion, there was a left posterior frontal parafalcine small hematoma which represented chronic blood products. He was transferred to the Neuro ICU for further management, where he remained obtunded with dense left hemiparesis until his death 27 days later. He had developed multiple infections, including pneumonia, tracheobronchitis and UTI during that time. In addition, he had multiple episodes of narrow complex supraventricular tachycardia with hemodynamic compromise and difficulty being weaned off of mechanical ventilation due to respiratory tract infections, as well as possible pulmonary embolism. Bilateral lower extremity DVTs were treated with placement of an inferior vena cava filter and Heparin. The day prior to death he developed acute renal failure and possible bowel ischemia. He died on the 27th day of hospitalization of multiorgan failure and sepsis. ---- At autopsy his brain weighed 1420 g unfixed. Cerebral subarachnoid and parenchymal hemorrhage was thought secondary to congophilic angiopathy which also involved the right posterior frontal lobe with microscopic infarcts. He had arteriolosclerosis and Alzheimer disease. It was thought that the hemorrhage led to the motor vehicle accident rather than derived from trauma itself since the patient had no other evidence of trauma within or outside the CNS.
