Lateralized ante mortem and post mortem pathology in a case of Lewy body disease with corticobasal syndrome

INTRODUCTION: Lewy body diseases are pathologically characterized by α‐synuclein pathology. Alzheimer's disease (AD) co‐pathology can influence phenotypes. In vivo AD biomarkers can suggest the presence of this co‐pathology in unusual cases, but pathological validation remains essential. METHODS: This patient originally presented with corticobasal syndrome and later developed visual hallucinations and parkinsonism consistent with a synucleinopathy. The patient underwent CSF sampling, 18F‐flortaucipir PET scanning, and brain donation with bilateral regions available for digital histological analysis. RESULTS: CSF Aβ42 and t‐tau were in the AD range. 18F‐flortaucipir scanning showed right‐lateralized retention in all lobes (t = 4.3‐10.0, P < .006). Neocortical stage Lewy body pathology and high levels of AD neuropathological changes were present at autopsy. There was right lateralization of α‐synuclein and tau pathology (T value = 3.1, P value = .007 and T value = 3.3, P value = .004 respectively). DISCUSSION: This case with overlapping tauopathy and synucleinopathy clinical features had in‐depth biomarker characterization and rare bilateral post‐mortem sampling showing lateralized tau and α‐synuclein pathology suggesting possible synergistic relationships.