PMC8595290_01
(A) Sagittal FLAIR MRI sequence showing cerebral atrophy with a frontotemporal predilection and post-ischemic hyperinsities in the white matter. (B) Axial FLAIR MRI sequence showing asymmetry of frontotemporal atrophy with left-side predominance. FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.
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MRI of the brain at this stage showed brain atrophy with frontotemporal predominance (Figure 1A), again with more severe impairment on the left side (Figure 1B).
Macroscopic and microscopic findings of histopathological examination of brain tissue. (A) Diffuse brain atrophy with the compensatory dilatation of the lateral and third ventricles; the atrophy was most pronounced in the frontotemporal regions, particularly in medial temporal lobes. (B) Lewy bodies in the neurons of the amygdala (HandE, magnification 400x). (C) Lewy bodies, dystrophic Lewy neurites and dots in the amygdala (alpha-syn 5G4, magnification 200x). (D) Neurofibrillary tangles and threads in the hippocampus (AT8, magnification 200x). (E) beta-amyloid deposits in the hippocampus (beta-amyloid, magnification 200x). (F) Plaques in the frontal cortex (AgNOR, magnification 100x).
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At the autopsy, the brain macroscopically showed diffuse symmetrical atrophy (total fixed brain weight was 1,050 g) with compensatory dilatation of the lateral and third ventricles; the atrophy was most pronounced in the frontotemporal regions, particularly in the medial temporal lobes (Figure 2A). Abundant Lewy bodies, dystrophic neurites and dots were found in the amygdala (Figure 2C), and the hippocampus and the cingular gyrus were similarly affected. The immunohistochemistry showed tau-protein positive deposits in the following regions: hippocampus, amygdala and cingular gyrus, neocortical regions (temporal, occipital, frontal, parietal, and motor cortices), basal ganglia, thalamus, and brainstem (midbrain and pons) (Figure 2D). The immunohistochemical examination with beta-amyloid antibody revealed extracellular parenchymal diffuse and focal deposits:plaques in the tissue samples taken from the neocortex (frontal, temporal, parietal, and occipital) and hippocampus (Figure 2E); other regions were negative. The silver impregnation (AgNOR) showed numerous diffuse, primitive as well as neuritic plaques in the cortices as well as in the limbic regions (Figure 2F).