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Washington University Experience | VASCULAR | Hemorrrhage - Subdural | 13A0 Case 13 History
Case 13 History ---- This patient had a 7-year history of gradually progressive decline in memory and thinking as well as a change in personality. A few transient dysfunctional episodes were thought to be related to episodes of hypotension rather than infarcts. Results of a CT done in December 2000, showed cerebral atrophy. In January 2003, he fell hitting his head with no identified immediate symptoms or residua. However, a CT scan in March 2003 showed a right subdural hematoma with mass effect which were treated with surgery. He was discharged to a skilled nursing facility and was no longer able to walk unassisted. In September 2003, he was hospitalized for aspiration pneumonia and had increasing difficulty swallowing, developed a fever, and died of inanition and pneumonia in late April at age 87. This gentleman had a 14-year history of gradually progressive cognitive decline. ---- At autopsy, the fresh brain weighed 1160g. Examination of the dura revealed an organizing subdural hematoma which is thickened and shows hemosiderin deposition, consistent with a remote hematoma. Histology of representative neocortical areas showed only sparse diffuse beta-amyloid plaques, but no neuritic plaques and are insufficient to meet the neuropathologic criteria for the diagnosis of Alzheimer disease by any diagnostic scheme. No other neurodegenerative diseases such as dementia with Lewy bodies, Pick's disease, etc. were identified. Vascular pathology was a prominent feature of this brain which included lacunar infarcts in basal ganglia, atherosclerosis and marked arteriosclerosis. These findings raise the possibility of vascular dementia but the pathology is not compelling for that as a stand-alone diagnosis. Certainly the vascular pathology may have contributed to the cognitive impairment, but may not fully account for the advanced dementia of this patient.
