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Dementia 02

Topic: Imaging

Created on Thursday, February 22 2007 by jdmiles

Last modified on Thursday, February 22 2007.

A 74 year-old female presents to your office accompanied by her sister, who provides most of the history.
The sister states that for quite some time, the patient has been increasingly forgetful, has complained of rigidity, occasionally will stare off into space for long periods of time, has had increasing difficulty inititiating movement, has had trouble keeping his balance, and has been distressed from seeing people in the room that nobody else sees.
Which of the following pathology findings is MOST characteristic of this patient's disease?

A) Neuronal aggregates

B) Punctate hemorrhages in periaqueductal grey and in the grey matter surrounding the 3rd and 4th ventricles

C) Lewy bodies

D) Amyloid plaques

E) Inclusions comprised primarily of American cheese

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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) neuronal aggregates

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. Neuronal aggregates and Bunina bodies are seen in amyotrophic lateral sclerosis. (See References)

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B) 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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C) Lewy bodies

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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D) amyloid plaques

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. Amyloid plaques are seen in DLB, but widespread Lewy bodies are a more defining feature. (See References)

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E) inclusions comprised primarily of American cheese

This answer is incorrect.

No. No, no, no. You are wrong. There is no American cheese in Lewy bodies. You are a silly person. (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