1. 65 year-old female who collapsed at home
Lananh Nguyen, M.D.
Division of Neuropathology
University of Pittsburgh Medical Center

2. An autopsy was performed. What do you see?

3. An autopsy was performed. What do you see?
Ischemic infarct

4. What areas in the brain are most vulnerable to hypoxic/ischemic encepthalopathy?

5. 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)

6. What type of cells do you see microscopically in an acute infarct?
Click here for cerebellum slide

7. What type of cells do you see microscopically in an acute infarct?
Red neurons (eosinophilic cytoplasm with loss of Nissl substance and pyknotic nuclei)

8. What are the predominant cells you see microscopically in a subacute infarct?

9. What are the predominant cells you see microscopically in a subacute infarct?
Macrophages and reactive glial cells

10. What are the predominant cells you see microscopically in a chronic infarct?

11. 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

12. There was another lesion. What do you see?

13. What do you see?
Hemorrhagic infarct

14. What are the 2 most common causes of nontraumatic brain hemorrhage?
Hypertensive vasculopathy
Cerebral amyloid angiopathy

15. What do you see?
Click here for virtual slide

16. What stain would you do to confirm diagnosis?

17. 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

18. What is your diagnosis for the cause of the cerebral hemorrhage?

19. Acute infarct from underlying Cerebral amyloid angiopathy (CAA)
What is your diagnosis for the cause of the cerebral hemorrhage?
Acute infarct from underlying
Cerebral amyloid angiopathy (CAA)

20. What is the most common cause of hereditary CAA?

21. Amyloid precursor protein (APP)
What is the most common cause of hereditary CAA?
Amyloid precursor protein (APP)