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Washington University Experience | VASCULAR | Subcortical Arteriosclerotic Encephalopathy | 4A0 Case 4 History
Case 4 History ---- The patient was a 66-year-old woman with a clinical history of suspected Alzheimer’s dementia, coronary artery disease, upper gastrointestinal bleed, hypertension, cerebrovascular accident, and rheumatoid arthritis with a recent admission to BJH in July 2007 for hypotension and aspiration pneumonia. On July 16, the patient had a ST elevation myocardial infarction that was medically managed in the CCU. The patient was readmitted to the Medical ICU on July 25 with polymicrobial septic shock and respiratory failure and was discharged to a nursing home. The patient presented on 08/2007 after an unwitnessed code at her nursing home. She was administered atropine and epinephrine and intubated in the field by EMS. On presentation to the BJH ED she remained pulseless with an unrecordable blood pressure. A palpable femoral pulse was restored in the ED although a manual blood pressure could not be obtained. The patient lost a pulse again and expired on 8/3. ---- At autopsy the weight of the unfixed brain was 1010g. There is severe arteriolosclerosis and prominent 'onion-skin' type thickening of the affected vessels. Some of the vessels are surrounded by hemosiderin-laden macrophages, suggesting prior hemorrhage. There is no evidence of vasculitis, microthrombi, granular deposits, or amyloid deposition within the microvasculature. Staining for LFB/PAS shows changes ranging from myelin pallor to myelin loss to frank infarction. Bielschowsky silver staining shows axonal loss and spheroids within areas of infarction. Sections of the basal ganglia and thalamus demonstrate similar ischemic lesions and microvascular changes. Her final diagnosis was subcortical arteriosclerotic encephalopathy. There was no evidence of Alzheimer disease using any grading schema.
