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Washington University Experience | VASCULAR | Subcortical Arteriosclerotic Encephalopathy | 2A0 Case 2 History
Case 2 History ---- The patient was a 60 year old man with multiple medical problems consisting of severe congestive heart failure, multiple prior cerebrovascular accidents, dementia, hypertension, diabetes, peripheral vascular disease status-post left femoral shunt, chronic kidney disease (creatine ~3), and C.difficile. He was admitted in May 2008 for tachypnea and mental status changes. He had a witnessed aspiration of his tube feeds en route to the hospital from his nursing home. He was intubated for respiratory failure. He developed ventricular tachycardia, ventricular fibrillation and then asystole on 5/17. ---- At autopsy the unfixed brain weighed 1200g. Sections of the neocortices confirm the gross impression and show remote infarcts in the right and left occipital lobes with cystic tissue loss, macrophages, and reactive astrocytosis. The right parietal infarct is more subacute in nature, compared to the other infarcts. In other areas of the neocortex there is a relatively well maintained complement of neurons. No diffuse or neuritic plaques, Pick bodies, ballooned cells, Lewy bodies, amyloid angiopathy, or glial inclusions are seen in H&E, Bielschowsky, thioflavin S, tau, beta-amyloid, and synuclein stained material. Staining for PHF protein reveals a few pretangles and a rare neurofibrillary tangle within a section from the hippocampus. The white matter generally shows multiple areas of ischemic damage ranging from myelin pallor with edema to well-defined remote infarcts with pallor, reactive astrocytosis, spheroids, and macrophages. There is severe arteriolosclerosis with thickened sclerotic arterioles accompanying white matter lesions. Some of the vessels are surrounded by hemosiderin-laden macrophages, suggesting prior hemorrhage. The final diagnosis was arteriolosclerosis, severe, with extensive subcortical ischemia consistent with SAE (Binswanger's Disease), one form of multi-infarct dementia.
