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Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 10A0 Case 10 History
Case 10 History ---- This 96 year old woman had a medical history which included hypertension, coronary artery disease requiring stent placement, atrial fibrillation, pacemaker placement, hyperlipidemia, and a possible TIA in 10 years prior during which she was speaking gibberish for one hour. Her son, had noted subtle memory changes with very slight gradual progression over 5 years. Her working diagnosis was Alzheimer’s dementia. Eight years prior to her demise she had a syncopal episode while driving and totaled her car. She also had auditory and visual hallucinations, increased shuffling of her feet, several falls and a stooped posture. On 4/4 she had a sudden onset of right-sided weakness and aphasia which was treated with TPA. A brain CT done on 4/5 showed a large left middle cerebral infarct with no evidence of hemorrhage. A widening of the cerebral sulci and ventricles was also noted. She died under hospice care at her son’s home on 4/10. ---- At autopsy the fresh brain weighed 1,390g. She received diagnoses of Alzheimer's disease, severe small vessel disease, cerebral amyloid angiopathy and a large hemorrhagic infarct in the territory of the left middle cerebral artery. This distribution and density of pathological changes warranted a neuropathological diagnosis of AD by Khachaturian, CERAD, and the NIA-Reagan Institute criteria.
