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Washington University Experience | VASCULAR | Small Vessel Disease | 13A0 Case 13 History
Case 13 History ---- The patient was an 82 year old man whose past medical history was significant for a stroke with no residual symptoms, a left subdural hematoma which had been drained, hypertension, Paget's disease, osteoporosis, neurofibromatosis, dementia, retinal vein thrombosis, and BPH. On presentation the patient was noted to be awake and fully oriented. The remainder of his neurologic examination was significant for possible weakness of the right lower face and hyperreflexia in the right upper extremity with an abnormally upgoing toe on the right to plantar stimulation. A prior MRI of the brain (December 1998), revealed moderate atrophy, a small subacute hemorrhagic infarct in the right basal ganglia, old left basal ganglia infarcts, and an old left thalamic stroke. A new head CT revealed no new infarcts. There was focal atrophy over the left temporal lobe with encephalomalacia, atrophy focally in the right parietal lobe, and periventricular white matter disease. Approximately eight hours later the patient was found to have a systolic blood pressure of 40 by Doppler with a heart rate of 100, and was unresponsive with agonal breathing. CPR was initiated, but was unsuccessful. ---- At autopsy the weight of the unfixed brain was 1300g. There were numerous cerebral infarcts, both subacute and remote, involving bilateral basal ganglia, left thalamus, periventricular white matter, and left mammillary body. Arteriosclerosis was accompanied by mild patchy leukoencephalopathy and nonspecific neurodegenerative changes. Alzheimer Disease Neuropathologic Change was not sufficient to explain his dementia and there is no definitive evidence of Parkinson's disease, cortical Lewy body dementia, or other common neurodegenerative diseases associated with dementia.
