Table of Contents
Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 11A0 Case 11 History - Copy
Case 11 History This 97 year old man had a past medical history significant for: childhood seizures, coronary artery disease, chronic atrial fibrillation, hypertension, hypercholesterolemia, congestive heart failure, diabetes mellitus, sick sinus syndrome, transient ischemic attack (TIA) and carotid endarterectomy 14 years prior to death and deep vein thrombosis 4 years prior to death. His surgical history included coronary artery bypass grafting and permanent pacemaker placed (12 years PTA), and femoral popliteal bypass grafting (5 year PTA). On 6/22 at age 97 he was ambulating with a walker and fell, fracturing his femoral neck with displacement. On 6/23 under general anesthetic in a two hour surgery he received an endoprosthetic replacement. Postoperatively, he had acute respiratory insufficiency and hypotension. His physical condition was further complicated by chronic renal disease and severe pulmonary hypertension in addition to his other known conditions. He did not regain consciousness and was mechanically ventilated. On 6/27 he had a massive right MCA cerebrovascular accident accompanied by acute renal failure and thrombocytopenia. In keeping with his directive, comfort measures only were instituted on 7/1 and he expired on 7/6. ---- At autopsy the unfixed brain weighed 1,200g. There was an area of acute/subacute hemorrhagic infarct involving the right middle cerebral artery territory in the occipital and parietal lobes. There were several vascular problems including severe arteriolosclerosis, moderate cerebral amyloid angiopathy and atherosclerosis. The major neurodegenerative findings were Alzheimer's disease and argyrophilic grain disease. Beta-amyloid plaques are frequent in some areas, but there are very few neurofibrillary tangles and no neuritic plaques in neocortical areas, indicating an early stage of Alzheimer's disease.
