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Washington University Experience | VASCULAR | Congophilic Angiopathy (CAA) | 9A0 Case 9 History
Case 9 History ---- This 74-year-old woman’s family reported a gradual decline in her short term memory over two years. She was, however, independent in community affairs, home & hobbies, and personal care. A brain MRI done in April 2005 showed small vessel disease in the periventricular white matter. Her neurological examination was unremarkable and she was rated CDR 0.5, DAT. but her memory was gradually declining. She was very active physically with dancing and biking, and maintained her household chores. While riding her bicycle in November of 2010, she felt weak, had a headache, and fell down. Upon admission to an ER she had a right frontal intraparenchymal hemorrhage with left upper extremity hemiparesis and became obtunded shortly thereafter with CT evidence that the hemorrhage nearly doubled in size with a midline shift. She died at age 78. At death, she was rated CDR 0.5. ---- At autopsy the fresh brain weighed 1180g. Major findings included a large left frontoparietal hemorrhage, CAA, and arteriolosclerosis. The diagnosis of Alzheimer disease is more nuanced in this patient with frequent beta-amyloid plaques, few neocortical neuritic plaques, and numerous neurofibrillary tangles present, consistent with the presence of Alzheimer disease by Khachaturian criteria, but the relatively low numbers of neuritic plaques is consistent only with 'possible' AD by CERAD criteria and a 'low' probability that the cognitive impairment is caused by AD according to the NIA-Reagan scheme.
