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Washington University Experience | VASCULAR | Infarct - Venous | 5A0 Case 5 History
Case 5 History ---- This patient was first seen at age 76 in 1994 with a strong family history of memory problems. She was diagnosed as Alzheimer’s disease by a neurologist in 1993 and started on Cognex. Her daughter reported a progressive problem with memory and thinking over a 2-year period. She was rated CDR 1, DAT. She continued to live independently in her apartment at age 78 and was rated CDR 1, DAT. She moved to an assisted living facility in the fall of 1996, and then moved to a nursing home in January 1997. In July 1997, she fell and fractured a hip, requiring the use of a walker. At the age of 80 her memory had deteriorated substantially. Her neurological examination showed some mild cogwheeling and some resting tremor in addition to a fine essential tremor. She was wheelchair bound, required total care, and was rated CDR 3, DAT. She died at 86. At autopsy the fresh brain weighed 1130g. The patient received diagnoses of definite DAT according to the criteria of Khachaturian, definite Alzheimer's disease according to CERAD, and high probability that dementia is caused by Alzheimer disease according to the NIA-Reagan Institute criteria. She also had argyrophilic grain disease and mild amyloid angiopathy. Lewy bodies were found in the superior temporal gyrus, amygdala and the substantia nigra, sufficient for the diagnosis of dementia with Lewy bodies. Completing the autopsy analysis was hippocampal sclerosis, sagittal sinus thrombosis with a hemorrhagic infarct of the right parietal lobe and small vessel disease (arteriolosclerosis)
