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Dementia 02

Topic: Imaging

Created on Thursday, February 22 2007 by jdmiles

Last modified on Thursday, February 22 2007.

A 69 year-old female presents to your office accompanied by her spouse, who provides most of the history.
The spouse states that for quite some time, the patient has complained of rigidity, has been distressed from seeing people in the room that nobody else sees, has been increasingly forgetful, has had periods when she is lethargic and drowsy, and others when she is more alert, developed a tremor, and has had worsening bradykinesia.
Which of the following pathology findings is MOST characteristic of this patient's disease?

A) Inclusions comprised primarily of alpha-synuclein

B) Bunina bodies

C) Neuronal aggregates

D) Neurofibrillary tangles,

E) Amyloid plaques

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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 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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B) 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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C) 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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D) neurofibrillary tangles,

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. Neurofibrillary tangles tend to be sparse in DLB. Neurofibrillary are more commonly associated with Alzheimer disease. (See References)

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E) 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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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