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Dementia 02

Topic: Imaging

Created on Thursday, February 22 2007 by jdmiles

Last modified on Thursday, February 22 2007.

A 90 year-old male presents to your office accompanied by his son, who provides most of the history.
The son states that for the past 18 months, the patient has complained of a tremor in his hands, has been increasingly slow getting around, has had periods when he is lethargic and drowsy, and others when he is more alert, has been forgetting things more frequently, lost his balance a few times, and has been seeing visions of flying teal poodles.
Which of the following pathology findings is MOST characteristic of this patient's disease?

A) Inclusions comprised primarily of Swiss cheese

B) Lesions in the mammillary bodies

C) Inclusions comprised primarily of tau protein

D) Inclusions comprised primarily of Huntingtin

E) Inclusions comprised primarily of alpha-synuclein

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This question was created on February 22, 2007 by jdmiles.
This question was last modified on February 22, 2007.

ANSWERS AND EXPLANATIONS

A) inclusions comprised primarily of Swiss cheese

This answer is incorrect.

Oh, come on. Swiss cheese? (See References)

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B) lesions in the mammillary bodies

This answer is incorrect.

This patient's history is consistent with dementia with Lewy bodies (DLB). Patients with DLB develop Parkinsonian symptoms and dementia symptoms at approximately the same time. Other key clinical features include recurrent visual hallucinations and fluctuations in mental status. Lesions in the mammillary bodies are seen in Korsakoff amnestic state. (See References)

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C) inclusions comprised primarily of tau protein

This answer is incorrect.

This patient's history is consistent with dementia with Lewy bodies (DLB). Patients with DLB develop Parkinsonian symptoms and dementia symptoms at approximately the same time. Other key clinical features include recurrent visual hallucinations and fluctuations in mental status. Lewy bodies are eosinophilic cytoplasmic inclusions comprised mainly of alpha-synuclein, not tau protein. (See References)

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D) inclusions comprised primarily of Huntingtin

This answer is incorrect.

This patient's history is consistent with dementia with Lewy bodies (DLB). Patients with DLB develop Parkinsonian symptoms and dementia symptoms at approximately the same time. Other key clinical features include recurrent visual hallucinations and fluctuations in mental status. Lewy bodies are eosinophilic cytoplasmic inclusions comprised mainly of alpha-synuclein. Huntingtin is a protein associated with Huntington chorea. (See References)

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E) inclusions comprised primarily of alpha-synuclein

This answer is correct.

This patient's history is consistent with dementia with Lewy bodies (DLB). Patients with DLB develop Parkinsonian symptoms and dementia symptoms at approximately the same time. Other key clinical features include recurrent visual hallucinations and fluctuations in mental status. Lewy bodies are eosinophilic cytoplasmic inclusions which contain alpha-synuclein. (See References)

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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York.
2. DeKosky, S.T., Kaufer, D.I., and Lopez, O.L. (2004). The Dementias. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, 4th Edition. Butterworth Heinemann, Philadelphia. Pp. 1901-1951
3. Prayson, R.A., and Goldblum, J.R. (Eds.) (2005). Neuropathology. Elsevier, Philadelphia.

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imaging
Dementia 02
Question ID: 02220701
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 02/22/2007
Modified: 02/22/2007
Estimated Permutations: 0