Table of Contents
Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 4A0 Case 4 History
Case 4 History ---- This patient has a very strong family history of dementia. By the time of neurologic evaluation in March 1994, he had global cognitive dysfunction. An MRI reportedly showed "multiple small cerebral and cerebellar infarcts, many involving the white matter." In October 1996, he was admitted to the Newton Medical Center in Kansas for new onset generalized tonic-clonic seizures. Head CT scan showed a right anterior temporal cerebral hemorrhage. Risperdal and Ativan were used during his hospitalization for behavioral control. Following discharge on 10/11, he had a head CT scan (10/21) that reportedly demonstrated both right and left cerebellar hemispheric lucencies and a right frontal lobe lacunar infarct in addition to the resolving right anterior temporal hemorrhage which was associated with encephalomalacia. Eventually, intravenous phenytoin and oral Phenobarbital controlled his seizures. He had left hemiparesis; it was unclear whether there was a new cerebral infarction (discharge summary report indicated that the CT scan showed "no new strokes or bleeds") or whether a previously compensated right cerebral hemispheric stroke now was "unmasked." At discharge, the left hemiparesis persisted and he was unable to walk. At the nursing home he apparently aspirated and died of aspiration pneumonia in February 1998 when he was 61 years of age. ---- At autopsy his unfixed brain weighed 1320 g. He received a diagnosis of Alzheimer's disease, with numerous neocortical senile plaques and tangles with congophilic angiopathy, numerous microscopic and macroscopic infarcts and hemorrhages, chiefly involving cerebral hemispheres and deep grey nuclei.
