This shows thickening of the vessel walls could be from CAA or from hypertension, the pathologist said. We saw frequent plaques enough to make a diagnosis of Alzheimers, but not enough to make a diagnosis of CAA. When I showed this to other pathologists, they thought it was more hypertensive, although clinical correlation was needed. But its interesting to note that problems from hypertension are usually in more central areas of the brain.
So, we would favor a diagnosis of hypertensive arteriosclerosis, the first pathologist summarized, although it would have been helpful to be able to examine the entire body. He was referring to my familys request to limit the autopsy to the brain only, and I can see how that handicapped him.
Given the utter absence of hypertension, though, wouldnt that push you towards another diagnosis? asked one of the neurologists.
Not necessarily. In an autopsy, we often see changes consistent with hypertension even if the patient was not hypertensive. These changes might be caused by other factors cardiovascular, for instance.