Eight years prior to his demise, this 48-year-old black male had a dissecting aortic aneurysm. The first portion of the aortic arch was dilated with an and he had associated aortic valve insufficiency. The defect was repaired and a mechanical prosthetic aortic valve was implanted. One year prior to his terminal admission, the patient experienced a catastrophic cerebrovascular accident (CVA) with left hemiparesis and obtundation. The patient experienced severe neurologic sequelae from this CVA and was eventually transferred to a nursing home where he was bedbound and required an indwelling urinary catheter. The Four months later the patient developed a urinary tract infection and was transferred to the hospital. The patient's condition deteriorated and he died 6 weeks after admission with a urinary tract infection and pneumoniaand he died of sepsis.

== Autopsy Findings ==Autopsy showed the expected findings in the aorta and in a 760-gram heart. The mechanical valve showed some deterioration and there was old thrombotic material adherent to the valve, which was probably the source of the emboli which caused the patient's CVA. The patient's 1250-gram brain showed extensive old infarctions in at least three different areas, with the largest (12.5 x 5.5 cm) in the distribution of the right middle cerebral artery.

File:IPLab3BrainInfarction3IPLab3BrainInfarction3b.jpgJPG|This is a low-power photomicrograph of this brain at the edge with several areas of the infarctinfarcted tissue. Note the pale areas which correspond to areas with loss of brain parenchyma (arrows).File:IPLab3BrainInfarction4IPLab3BrainInfarction4b.jpgJPG|This is a photomicrograph of shows the edge area of the infarct. Note the numerous inflammatory cells in the healed/healing infarction (I) and more normal brain parenchyma and adjacent to the remaining brain tissue (arrowsB).File:IPLab3BrainInfarction5IPLab3BrainInfarction5b.jpgJPG|This is a higher-power photomicrograph of the previous image showing that the inflammatory cells area of healed/healing infarction (arrowsI) are primarily macrophages and more normal brain parenchyma (B). In the infarcted area contains numerous microglia which (brain macrophages) that have phagocytosed dead brain cell debris that are called "gitter cells". In the dead more normal brain tissuethere are several enlarged astrocytes. These activated astrocytes are often seen in areas of healing and they are called "gemistocytic astrocytes".File:IPLab3BrainInfarction6IPLab3BrainInfarction6b.jpgJPG|This is a higher-power photomicrograph of the brain tissue adjacent to the area of infarctioninfarct. There In this image there are numerous enlarged activated astrocytes that are often seen in areas of brain healing - gemistocytic astrocytes (arrows).File:IPLab3BrainInfarction7IPLab3BrainInfarction7b.jpgJPG|This is a higher-power photomicrograph of the edge of the infarct. The infarcted brain tissue with numerous macrophages (microglia) that are full of brain tissue (“gitter cells”) are at the top of the image (arrows) and the brain parenchyma containing gemistocytic astrocytes is at the bottom.File:IPLab3BrainInfarction8.jpg|This is a high-power photomicrograph of gitter cells (arrows).File:IPLab3BrainInfarction9.jpg|This is a photomicrograph of the edge of the infarct. Note the gitter cells, gemistocytic astrocytes, and some hemosiderin-laden macrophages (arrows).

 === Related IPLab Cases ===* [[IPLab:Lab 8:HSV Encephalitis|Lab 8: Brain: Herpes Encephalitis]]* [[IPLab:Lab 8:Rabies|Lab 8: Brain: Rabies]]