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Washington University Experience | VASCULAR | Subcortical Arteriosclerotic Encephalopathy | 5A0 Case 5 History
Case 5 History ---- This patient was first seen at 88 years of age with a positive family history for dementia affecting 2 brothers. She was an alcoholic, and in her ‘50s experienced "blackouts". Her son monitored the subject's alcohol intake for the 20 or 25 years but she continued to drink excessively during most of the period before nursing home admission. When the patient was approximately 78 years of age, she had difficulty with language and her personal appearance. By 1981 she was admitted to a nursing home. In 1984, she experienced a stroke with subsequent right hemiparesis and dysarthria and used a walker thereafter. She was unable to find her way in the nursing home and was occasionally incontinent. She was rated as probable DAT, CDR 2 (moderate dementia). The patient continued to deteriorate cognitively. When she was 93 years of age she required total care and was mute and was rated CDR 3 (severe dementia). On January 6th she developed pulmonary congestion and cough and was found dead in her bed the next day, presumably of pneumonia. ---- At the time of autopsy a Bielschowsky preparation showed only isolated tangles which were unaccompanied by senile plaques. H&E preparation of the hippocampus fails to reveal any Hirano bodies or granulovacuolar degeneration. Numerous lacunar infarcts are found in the globus pallidum, putamen, midbrain and pons and in the subcortical and centrum semiovale, particularly in the occipital and parietal lobes. In the cerebellum there is a mild loss of Purkinje cells at the crest of the folia with a mild reactive Bergmann gliosis described in the anterior superior vermis; however the mammillary bodies appear normal. The large vessels at the base of the brain show arteriosclerosis but no significant occlusion of lumina. ---- There is no evidence of Alzheimer's disease or any other neurodegenerative disease to account for this patient's dementia. Although the vascular lesions do not constitute a large lesion volume in the white matter, some are strategically located, particularly the thalamus, subiculum and amygdaloid nucleus and were thought to account for the majority of her cognitive problems. The final diagnosis was multi-infarct dementia
