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Washington University Experience | VASCULAR | Small Vessel Disease | 5A0 Case 5 History
Case 5 History ---- The decedent was a 97 year-old woman with a history of dementia, congestive heart failure, and stroke. She presented to the ER with altered mental status (from a baseline of advanced dementia), slurred speech, a limp left hand, and a three-day history of inability to feed herself. Brain MRI revealed two small 4-5 mm foci of diffusion restriction (and low signal on ADC MAP) in the right frontal convexity, also involving the subcortical white matter and centrum semiovale. Also identified was an adjacent minute right frontal chronic infarct, chronic left and right thalamic lacunar infarcts, and mild involutional change with microvascular disease. MR angiography showed multiple vascular channel stenoses. She was not considered a good candidate for aggressive anticoagulation given her age and advanced dementia, and was continued on aspirin. She presented to the ER with hypotension but soon became less unresponsive. She was diagnosed with sepsis and IV antibiotics were administered but she passed away. ---- At autopsy the weight of the unfixed brain is 1010g. Diffuse Lewy body disease was accompanied by remote infarcts involving the right posterior frontal cortex including precentral gyrus, brainstem, centrum, centrum semiovale with marked arteriolosclerosis and atherosclerosis.
