Tottori J. Clin. Res. 9(2), 164-175, 2017

Short Neuropathological Report

A case of cerebral infarction with separate episodes of embolism within a 12-year
interval, associated to mild Alzheimer-type lesions identified at autopsy
Yoshihiro Konishi1)*, Hiroyuki Nakayasu2), Hiroshi Nasu3), Hirotake Nishimura4)
1) Department of Clinical Research, NHO Tottori Medical Center2) Department of Neurology, Tottori Prefectural Central Hospital3) Department of Cardiology, Tottori Prefectural Central Hospital4) Department of Pathology I, Kawasaki Medical School*Correspondence: ykonishi@tottori-iryo.hosp.go.jp
Abstract
A 73-year-old patient experienced an episode of cerebral infarction of the right middle cerebral artery(MCA) region, followed by a second episode of cerebral infarction of the left posterior cerebral artery (PCA)
region at the age of 85. Atrial fibrillation was observed during both episodes and a diagnosis of cardiogenic
cerebral embolism was given. An autopsy was performed on the patient’s brain one hour and 15 minutes
postmortem. Based on the pathological findings, the following questions, which were raised from a clinicalperspective, were taken into account. (i) Was the cerebral infarction of this patient due to embolism? (ii) Ifcerebral embolism was the cause, was it cardiogenic? (iii) Did atherosclerosis cause the occlusion of the rightinternal carotid artery (ICA)? Did the atheroma of the right ICA produce emboli? (iv) If dementia had been
diagnosed clinically on this patient, would it be linked to vascular dementia? (v) Were the cerebrovasculardisease (CVD) lesions accompanied by any dementia-inducing neurodegenerative lesions? (vi) Could thispatient be diagnosed with vascular dementia, Alzheimer’s disease (AD), or mixed dementia? (vii) Was therestraint of the patient over the course of three plus years a possible cause of the AD pathological changes
observed in the brain?
Cholesterol emboli induced the infarct lesions. There were originally produced in sited located outside ofthe brain, probably in the aorta and its branches. The patient was diagnosed as having mixed AD (intermediateto high likelihood of AD, based on the National Institute on Aging (NIA)–Reagan Institute (RI)
neuropathological criteria for AD) and probable vascular dementia. Furthermore, prolonged restraint of thepatient may have contributed to AD pathological changes. Tottori J. Clin. Res. 9(2), 164-175, 2017
Key words: cerebral infarction, cerebral embolism, atherosclerosis, Alzheimer-type histological lesion, restraint
stressClinical course
A 73-year old patient had an episode of
cerebral infarction of the right MCA region,
followed by a second episode of cerebral
infarction of the left PCA region at the age of 85(Fig. 1). Atrial fibrillation was observed during
both episodes and a diagnosis of cardiogenic
cerebral embolism was performed. However,mural thrombi were not identified following anechocardiography. At the age of 75, the patientunderwent a magnetic resonance angiography(MRA) and carotid ultrasonography, which
fortuitously revealed occlusion of the right ICA(Fig. 2). Following a cerebral infarction at theage of 73, the patient experienced no sequela.
However, around the age of 83, the patient
started experiencing, among others, clinicalsymptoms such as irritability, dysgraphia,
disheveled clothes, buying the same items
repeatedly, depressive episodes and low medicat-