CASE HISTORY

The patient was admitted with severe recent dyspnoea and signs of heart failure. He was badly disorientated and was unable to give any satisfactory account of himself. He showed signs of myocardial infarction and as his cardiac failure increased his mental state deteriorated and he developed a confusional insanity. He finally died a week after admission, with gross circulatory failure.

PATHOLOGY

Brain 215mmx165mmx75mm. The brain has been divided horizontally and the two halves mounted in separate pots. The main cerebral vessels show gross atherosclerosis. They are large and tortuous and their walls are thick and opaque with patchy foci of increased whiteness due to lipoid deposits. The cut ends of the main vessels show grossly diminished lumina. The brain itself is atrophied though its weight was only a little reduced (1420 grams). Over the vertex the convolutions are shrunken and the sulci are consequently widened; this is more marked in the anterior 2/3. This atrophy can be seen on the cut surface as a thinning of the cortical grey matter. The generalised atrophy of the brain tissue has caused an enlargement of the lateral and third ventricles. There is a minute focus of old cerebral softening in the anterior part of the left caudate nucleus.

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