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Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 26A0 Case 26 History
Case 26 History ---- The patient is an 85 year old woman with a history of hypertension, osteoporosis, atrial fibrillation on Coumadin for anticoagulation, breast cancer (no information regarding diagnosis is available), and end stage Alzheimer dementia (oriented only to self at baseline) which slowly progressed over the last 6-8 years), who presented to her son with altered mental status. The patient had nurses who provided continuous home health care. Her son brought her to the hospital on 2/9 after noticing healing bruises on her face in addition to decreased mental status. She had no known history of recent falls. She was taking Coumadin for anticoagulation due to atrial fibrillation; INR on admission was 5.7. A head CT showed diffuse intraparenchymal hemorrhages in the left frontoparietal and right frontotemporal regions as well as diffuse subarachnoid hemorrhage. No fractures were found. A repeat CT on 2/10 showed stable intraparenchymal hemorrhages and mild interval increases in subarachnoid hemorrhages. She was treated with supportive care and reversal of anticoagulation. After discussions with the family her care was redirected to comfort measures only. ---- Autopsy showed an 1130 g atrophic brain. She had subacute hemorrhages involving bilateral insular lobes, with subarachnoid extension and prominent congophilic angiopathy with severe arteriolosclerosis. The frequency and distribution of the neuritic plaques and neurofibrillary tangles meet the CERAD, NIA/Reagan, and Khachaturian criteria for the diagnosis of Alzheimer’s disease.
