1 / 15

Clayton Wiley MD/PhD

Clayton Wiley MD/PhD. Question 1. This is a 79-year-old woman who presented to an outside hospital following sudden onset of severe headache and left sided weakness. A CT scan of the head was performed. Describe the CT scan findings. Question 2.

maxbeltran
Download Presentation

Clayton Wiley MD/PhD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Clayton Wiley MD/PhD

  2. Question 1 • This is a 79-year-old woman who presented to an outside hospital following sudden onset of severe headache and left sided weakness. A CT scan of the head was performed. • Describe the CT scan findings.

  3. Question 2 • What is the differential diagnosis of a spontaneous intracranial hemorrhage?

  4. Answer • Metastatic tumor • Primary CNS tumor • Hemorrhagic Infarct • Vascular Malformation • Amyloid Angiopathy • Coagulopathy • Infection

  5. Question 3 • The blood was evacuated and the tissue sent for pathologic examination. Describe the findings. • Click here to review the slide

  6. Question 4 • What immunohistochemical stains would you order to help better characterize the etiology of this hemorrhage?

  7. Answer • A-beta amyloid • Smooth muscle actin • Pankeratin (to rule out carcinoma not readily apparent on the slide) • PAS (to rule out CADASIL – see question XX) • Click to see A-beta amyloid, Actin, PAS

  8. Question 5 • Based on the clinical history, H&E impression and immunohistochemical findings (see below), what is your diagnosis?

  9. Answer • A. Cerebral Amyloid Angiopathy • B. Alzheimer’s Disease Pathology

  10. Question 6 • What causes cerebral amyloid angiopathy and how is it related to other forms of amyloidosis?

  11. Question 7 • What is amyloid?

  12. Question 8 • What is the most common cause of spontaneous intracranial hemorrhage and how is the clinical presentation of cerebral amyloid angiopathy different?

  13. Answer • Hypertensive vasculopathy (HV) is the most common (70-90%). • CAA most prominently involves the leptomeningeal and cortical vessels. Commonly found in demented individuals with Alzheimer’s like pathology. • HV typically causes hemorrhages in the basal ganglia (40-50%), lobar regions (20-50%), thalamus (10-15%), pons (5-12%), cerebellum (5-10%), and other brainstem sites (1-5%). More commonly fatal (rapid).

  14. Question 11 • This patient also had amyloid plaques deposited in the surrounding cortex. How closely associated is CAA with Alzheimer’s disease?

More Related