18th Annual Neurology Board Review Course Pre-Test

4/4 : 4. Previous Show Results

A 56-year-old man with a history of migraine with aura since childhood and subcortical ischemic strokes
first diagnosed at age 45 presents for evaluation of cognitive decline. Mental status examination is notable
for decreased attention and impaired executive function. MRI showed extensive T2 hyperintensities in the
subcortical white matter including the external capsule and the anterior temporal lobes bilaterally. Skin
biopsy is most likely to show:

Lipohyalinosis in small vessels

Positive congo-red staining around vessels
Non-amyloid granular osmiophilic material within the media of vessels
Medial fibroplasia and loss of the internal elastic membrane of vessels
None of these above

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