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Week 15

 

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Quiz 15 Context:

An 82 year-old-male presents to your clinic with his children. The family relates that their father has suffered for several years from memory loss, confusion, and depression. More recently the patient has become combative and erratic.

Past medical history is significant for hypertension and hyperlipidemia. The patient suffered a head injury with subsequent hearing impairment at age 42. There is a family history of dementia. Social history reveals the patient completed primary schooling only. The patient reportedly used alcohol heavily and smoked throughout his life.

Physical examination reveals a thin male in no acute distress. Vital signs reveal a pulse of 82, blood pressure of 166/54. Fundoscopy shows no papilledema. Neurologic and mental status examination reveal impairments in both short and long term memory and language skills. Additionally, there is demonstrable tremor, gait disturbance, apraxia, acalculia, and frontal lobe release phenomena.

Before a thorough work-up is completed, the patient succumbs to pneumonia and dies. The family requests a post-mortem examination to definitively diagnose the cause of his cognitive decline.

A post-mortem examination is performed; pathologic specimens of brain tissue are shown above.

This finding, in the context of the clinical history given, is most consistent with which of the following?

  1. Alzheimer's disease
  2. Encephalitis
  3. Multiple sclerosis
  4. Parkinson's disease
  5. Brain trauma with hemorrhage

 

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Copyright © 2000-2011 The Cleveland Clinic Foundation. All Rights Reserved.
Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195