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Washington University Experience | VASCULAR | Infarct - Venous | 2A0 Case 2 History
Case 2 History ---- This 57 year-old man had a medical history of a 20-years of radium implants for treatment of prostate cancer and psychiatric treatment for affective disorder. A CT scan done in March 1991 (his mother had AD and he was concerned about possible early dementia) was “normal”. Clinically, he was thought to have “questionable dementia, possible Alzheimer’s disease (AD)” and “chronic minor affective disorder”. At a follow-up visit in April 1993, he was very depressed and ineffective at work. By the time of his April 1995 visit, he was CDR 0.5, DAT with depression resolving on Zoloft. In June 1995 he had a bladder resection for cancer. By January 1997, he was rated CDR 1 and started on Aricept. The patient was admitted to a residential care facility in May of 1998. In October 2002 when he was hospitalized for tonic-clonic seizures, he developed staph urosepsis and died on 2002 at age 69. At the time of his death, the patient was a CDR 3 and required total personal care. Thus, he had a 14-year history of gradual cognitive decline. He was reported to have seizures with subsequent rigidity, hallucinations, and visual neglect late in the course of his illness. ---- At autopsy the weight of the unfixed brain was 1270 g. The superior sagittal sinus was thrombosed and clot extended into adjacent superficial parieto-occipital cortical veins resulting in venous infarction/necrosis. He received a diagnosis of DAT using the CERAD and Khachaturian criteria.
