PMC3500405_01
T1-weighted coronal section MRI at 10 years into illness shows marked temporal greater than frontal atrophy, as well as insular atrophy. The atrophy is also asymmetric, worse on the right than on the left. Also note involvement of the hippocampi.
nihms-396067-f0001.jpg
PMC3500405_01_nihms-396067-f0001.jpg
F1
An MRI of the brain at 10 years showed severe atrophy of both temporal lobes and mild to moderate atrophy in frontal and insular regions (see Figure 1).
H and E stained sections of insular cortex from an individual with no neurocognitive abnormalities, photographed at low (a1) and high (b1) magnification Center panels a2 and b2 show insular cortex from a patient with Alzheimer disease. Panels at right (a3 and b3) show insular cortex from the patient described in this case report, with most marked neuron loss and pronounced astrocytic gliosis.
nihms-396067-f0002.jpg
PMC3500405_01_nihms-396067-f0002.jpg
F2
Marked neuronal loss with astrocytic gliosis and focal spongy change in neocortex was seen on H & E stain, especially involving superficial cortex of the frontal and temporal lobes and insular neocortex (Figure 2).
Sections of insular cortex from patient described in this case report. Note occasional plaque-like distribution of tau-immunoreactive neurites, a rare finding within the cortex (a), thread-like ubiquitin-immunoreactive processes in the neuropil throughout all cortical regions (including insula) (b,c) and prominent TDP-43 immunoreactivity of cytoplasmic inclusions, apparently within neuronal cell bodies (d).
nihms-396067-f0003.jpg
PMC3500405_01_nihms-396067-f0003.jpg
F3
There were rare cells (including scattered neurons) with cytoplasmic TDP-43 immunoreactivity and a 'neuritic' pattern of ubiquitin immunoreactivity was noted in many cortical regions, including the insular cortex (Figure 3).