Transcript UPMC PowerPoint - University of Pittsburgh

65 year-old female who collapsed at home
Lananh Nguyen, M.D.
Division of Neuropathology
University of Pittsburgh Medical Center
An autopsy was performed. What do you see?
2
An autopsy was performed. What do you see?
Ischemic infarct
3
What areas in the brain are most vulnerable to
hypoxic/ischemic encepthalopathy?
4
What areas in the brain are most vulnerable to
hypoxic/ischemic encepthalopathy?
• Sommer sector of the Hippocampus (CA1)
• Purkinje layer of the Cerebellum
• Deeper layers of the Cortex (Layers 3 and 5)
5
What type of cells do you see microscopically in an acute
infarct?
• Click here for cerebellum slide
6
What type of cells do you see microscopically in an acute
infarct?
• Red neurons (eosinophilic cytoplasm with loss of Nissl
substance and pyknotic nuclei)
7
What are the predominant cells you see microscopically in
a subacute infarct?
8
What are the predominant cells you see microscopically in
a subacute infarct?
• Macrophages and reactive glial cells
9
What are the predominant cells you see microscopically in
a chronic infarct?
10
What are the predominant cells you see microscopically in
a chronic infarct?
• Reactive glial cells
Note on low power the cystic space formed after an infarct
11
There was another lesion. What do you see?
12
What do you see?
Hemorrhagic infarct
13
What are the 2 most common causes of nontraumatic
brain hemorrhage?
• Hypertensive vasculopathy
• Cerebral amyloid angiopathy
14
What do you see?
• Click here for virtual slide
15
What stain would you do to confirm diagnosis?
16
What stain would you do to confirm diagnosis?
-
Beta amyloid protein immunohistochemical stain
(below) shows thickened circumferential staining of
vessels
-
Congo red stain (not shown) will highlight vessels as
apple-green birefringence on polarized light
Thickened, hyalinized vessel
17
What is your diagnosis for the cause of the cerebral
hemorrhage?
18
What is your diagnosis for the cause of the cerebral
hemorrhage?
Acute infarct from underlying
Cerebral amyloid angiopathy (CAA)
19
What is the most common cause of hereditary CAA?
20
What is the most common cause of hereditary CAA?
Amyloid precursor protein (APP)
21