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Dementia 02

Topic: Imaging

Created on Thursday, February 22 2007 by jdmiles

Last modified on Thursday, February 22 2007.

A 63 year-old female presents to your office accompanied by her mother, who provides most of the history.
The mother states that for the past 2 years, the patient has complained of a tremor in his hands, has complained of rigidity, has been forgetting things more frequently, has had increasing difficulty inititiating movement, occasionally will stare off into space for long periods of time, and has been seeing visions of flirtatious white vampire bats.
Which of the following pathology findings is MOST characteristic of this patient's disease?

A) Amyloid plaques

B) Inclusions comprised primarily of Swiss cheese

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

D) Bunina bodies

E) Lewy bodies

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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) 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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B) inclusions comprised primarily of Swiss cheese

This answer is incorrect.

Oh, how cute. You chose the silly answer. (See References)

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

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E) 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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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