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Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 8A0 Case 8 History
Case 8 History ---- This retired 78 year old man had a medical history significant for diabetes, hypertension, hypercholesterolemia, asthma, peripheral neuropathy, prostatectomy (1998), GI bleed (2010), and a long history of depression. His medications included Aricept, Namenda, sertraline, and trazodone. His wife noticed memory and thinking problems over 2 years. His neurologic exam was notable for distal sensory motor neuropathy with significant weakness both proximally and distally in the lower extremities. His physician thought he had incipient Alzheimer disease with Lewy body dementia. He became much weaker physically during April 2012 and died in May at age 79 of a stroke which occurred the day prior. ---- At autopsy his unfixed brain weighed 1,400g. Neuropathologic studies were consistent with Alzheimer's disease National Institute on Aging-Alzheimer's Association (NIA-AA) rating (A3B1C1) criteria with a few brainstem Lewy bodies of low possibility for cognitive impairment. Acute hemorrhagic infarcts involved left and right middle cerebral arterial distributions with subarachnoid hemorrhage and a possible watershed infarct in the cerebellum. Both hemispheres show hemorrhagic infarction involving the vascular territory of the MCA, suggestive of possible embolism although possible sources (e.g., cardiac) were not examined in line with the restrictions of the autopsy.
