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A patient with long term severe hypertension develops progressive dementia. CT scan of the head demonstrates a diffuse loss of deep hemispheric white matter. Which of the following terms best describes the pathological process that is occurring?
A. Anemic infarcts
B. Hemorrhagic infarcts
C. Hypertensive encephalopathy
D. Lacunae
E. Subcortical leukoencephalopathy
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i guess as far as i knw subcortical leucoencaph n vascular dementia r basically go hand in hand...
so i chose subcortical i guess came meanings diff names
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The correct answer is E. This patient has subcortical leukoencephalopathy (Binswanger's disease), which is one of the neurologic syndromes associated with hypertension. It is
uncommon, but obviously devastating. The histologic findings are diffuse, irregular loss of axons and myelin accompanied by widespread gliosis. Small infarcts may be seen in the frontal lobes. The pathologic mechanism may be damage caused by severe arteriolosclerosis. None of the other choices would produce diffuse subcortical white matter involvement.
Anemic infarcts (choice A) can be seen in hypertensive patients as a consequence of atherosclerotic
thromboembolic events.
Hemorrhagic infarcts (choice B) can also be seen in hypertensive patients as a consequence of
atherosclerotic thromboembolic events followed by reperfusion. They tend to occur in gray matter or at the gray-white junction.
Hypertensive encephalopathy (choice C) is an acute generalized dysfunction of the brain that can occur in malignant hypertension or other very severe hypertensive processes. The primary pathology is seen in cerebral vessels, although cerebral edema may be present.
Lacunae (choice D) are small necrotic foci in deep gray matter (especially basal ganglia and thalamus) seen in some hypertensive patients
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thanks a lot OKT3 for the explanation.
