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Washington University Experience | VASCULAR | Small Vessel Disease | 11A0 Case 11 History
Case 11 History ---- The patient was a 70-year old man with a history of dementia of Alzheimer type, Parkinson disease, hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, recurrent urinary tract infection and coronary heart disease. The patient performed all his activities of daily living until September 2011, when he began to have episodes of forgetfulness and confusion. In late December, the patient fell from bed and struck his right supraorbital region on a table. He reportedly attempted to stand again but fell, struck his head on the ground and suffered a loss of consciousness. Over the following two days, the patient experienced a decline in mental status, was less interactive, exhibited difficulty swallowing and decreased movement of his left upper extremity. CT scan at an OSH showed an acute right convexity subdural hematoma extending from the right frontal pole to the occipital lobe with 7 mm of leftward midline shift. He was transferred to BJH, underwent a right frontotemporal parietal craniotomy for evacuation of his acute subdural hematoma on the 27th. He died on the 30th of Dec 2011 (post-operative day #3). A brain only autopsy was performed by permit. ---- At autopsy the weight of the unfixed brain was 1560g (with edema) and showed Alzheimer’s disease (NIA/AA intermediate change, A2B3C2), a large subdural right temporal/parietal/occipital hematoma was accompanied by right sided epidural hemorrhage. In this case characteristic features of Diffuse Lewy body dementia or TDP-43 deposition were not noted by morphological or immunohistochemical studies.
