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Washington University Experience | VASCULAR | Small Vessel Disease | 1A0 Case 1 History
Case 1 History ---- The patient was a 73-year-old woman with chronic hypertension and hypercholesterolemia found collapsed at home and admitted. Brain MRI showed small acute infarcts involving cortex, white matter, basal ganglia, brainstem and cerebellum with a hint of watershed distribution. She died shortly thereafter from a pulmonary embolus. ---- At autopsy the weight of the unfixed brain was 1000g. There were multiple, remote and subacute infarcts involving bilateral frontal lobes white and gray matter, corpus callosum, and frontal cortical microinfarcts, bilateral striatum, left temporal lobe, and remote changes in the left pons, left and right cerebellum. Infarcts were accompanied by moderate-to-severe arteriolosclerosis, atherosclerosis and hinted at a watershed distribution. A watershed pattern is more consistent with generalized hypoperfusion of large areas of the brain which were asymmetric in this case, likely reflecting the complex rheology of underlying vascular disease.
