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Dementia 02

Topic: Imaging

Created on Thursday, February 22 2007 by jdmiles

Last modified on Thursday, February 22 2007.

A 68 year-old female presents to your office accompanied by her sister, who provides most of the history.
The sister states that for the past 3 years, the patient has had dramatic fluctuations in her level of arousal, has been forgetting things more frequently, has complained of rigidity, developed a tremor, has had trouble keeping his balance, and has complained of seeing people in the room that nobody else sees.
Which of the following pathology findings is MOST characteristic of this patient's disease?

 
        A) Punctate hemorrhages in periaqueductal grey and in the grey matter surrounding the 3rd and 4th ventricles
 
        B) Inclusions comprised primarily of Huntingtin
 
        C) Lesions in the mammillary bodies
 
        D) Basophilic cytoplasmic inclusions
 
        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) punctate hemorrhages in periaqueductal grey and in the grey matter surrounding the 3rd and 4th ventricles

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. Punctate hemorrhages in periaqueductal grey and in the grey matter surrounding the 3rd and 4th ventricles are seen in Wenicke encephalopathy.  (See References)

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B) 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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C) 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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D) basophilic cytoplasmic inclusions

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.  (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

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