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May 15, 2019

ESOC-2019

CEREBRAL AMYLOIDANGIOPATHY AS A CAUSE FOR REVERSIBLE STROKE SYMPTOMS

;

cerebral amyloidangiopathy related inflammation

encephalopathy

reversible

stroke symptoms

Abstract

Abstract

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Keywords

cerebral amyloidangiopathy related inflammation

encephalopathy

reversible

stroke symptoms

Abstract

Background and aims: Cerebral amyloidangiopathy (CAA) is characterized pathologically by deposition of β-amyloid in cerebral and leptomeningeal blood vessels, which leads to degeneration of blood vessel walls causing microaneurysms and occlusions. This causes lobar hemorrhages and infarction, respectively. In some cases β-amyloid depositions lead to inflammation causing cerebral amyloidangiopathy-related inflammation (CAA-RI). Patients present with (sub-)acute encephalopathy, headache, epileptic seizures and/or focal neurological deficits. Methods: A 71-year-old man, known with hypertension and gout, presented to emergency department with confusion. At clinical assessment, confusion turned out to be aphasia together with homonymous hemianopia. CT-brain showed hypodensity parieto-occipital in the left hemisphere without cortical involvement suggesting edema. Additional MRI-brain showed large areas (bilateral occipital, temporal, parietal) with high signal intensity and swelling of white and gray matter with leptomeningeal enhancement. T2-weighted images and diffusion weighted images raised the suspicion of the presence of blood, there was no diffusion restriction. Gradient echo sequences confirmed the presence of superficial siderosis. This raised hypothesis of CAA-RI. Infectious causes were already excluded by cerebrospinal fluid and blood examination. Treatment with steroids started. Results: After few days of steroid treatment patient developed psychosis and psychiatrist started antipsychotics, finally patient recovered. MRI brain improved substantially within few weeks: Patient was discharged for rehabilitation. Conclusion: CAA-RI is a rare form of potentially reversible encephalopathy in subset of patients with CAA. Therefore early recognition is important.

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© Copyright 2019 Morressier GmbH.
All rights reserved.