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Washington University Experience | VASCULAR | Subcortical Arteriosclerotic Encephalopathy | 8A0 Case 8 History
Case 8 History ---- The patient was an 87 year old man who died of acute respiratory failure on the day of his admission to the hospital. The patient had multiple medical problems including: chronic renal insufficiency, prostate cancer, gastroesophageal reflux disease, severe aortic stenosis, osteoarthritis of the cervical spine, an old cerebrovascular accident with residual right hemiparesis, dementia, seizure disorder, and Parkinson's disease. He was transferred from the nursing home to BJH for severe respiratory distress and decreased level of consciousness. The patient was intubated in the ER and a chest x-ray revealed a right-sided pneumonia. He was hypotensive, requiring pressor support, and was transferred to the ICU where he failed to respond to optimal pressor therapy. A decision was made to withdraw support and the patient died. ---- At autopsy the weight of the unfixed brain was 1100 gm. The arteries at the base of the brain are normally distributed and showed patchy atherosclerotic disease. Remote lacunar infarcts involved the left periventricular white matter, left frontal lobe, and pons. Given the patient's age, the finding of moderate numbers of neuritic plaques in several areas of neocortex are consistent with Alzheimer's disease neuropathologic change, but do not allow a definitive diagnosis of Alzheimer’s disease using any of the modern criteria. It may be that this patient's dementia was multifactorial in etiology, with both the presence of early Alzheimer's disease as well as vascular disease contributing to the clinical findings of dementia. There are no additional findings within the substantia nigra and/or basal ganglia region to account for this patient's apparent parkinsonian symptoms. In summary, this patient has pathologic evidence of multiple old lacunar infarcts, a vasculopathy, and findings suggestive of Alzheimer's disease, all of which may have contributed to his dementia.
