Eveline Van Looy
TRANSIENT NEUROLOGICAL SYMPTOMS (TNS) HERALDING INTRACRANIAL HAEMORRHAGE IN PATIENT WITH CEREBRAL AMYLOID ANGIOPATHY (CAA): A CASE REPORT Case report A 71-year old woman presented to the emergency department (ER) in January 2019 with sudden onset transient faciobrachial hypoesthesia. Family mentioned that there had also been an episode of confusion earlier. Upon further questioning, her husband confirmed comprehension problems rather than confusion. She had been admitted a few months earlier because of a spontaneous intracerebral haemorrhage (ICH) which led to the probable diagnosis of CAA. Clinical examination and CT scan (see below) were both unremarkable and she was discharged with the diagnosis of an amyloid spell. Within 24 hours she was readmitted to the ER because of persisting confusion. Examination showed sensory aphasia. Urgent imaging revealed a large left parietal lobar haemorrhage. Imaging See poster Discussion The interesting aspect about this case is that the preceding episode of “confusion” was actually transient sensory aphasia, the exact same symptom with which she presented the following day. This time however the symptoms persisted, which prompted new imaging and the diagnosis of the haemorrhage. Our hypothesis is that the TNS might have been an, on CT imaging, undetectable microbleed, which then evolved into a lobar haemorrhage. Conclusion To our knowledge this is the first published case where an ICH occurred so early after TNS which presented itself with the same deficit. Of course this may be mere coincidence, however the close association in both timing and vascular territory might have been a herald of the ICH yet to come. Is it worth considering MRI imaging in the acute setting?
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