Cerebral amyloid angiopathy-related inflammation
Several months history of headaches and progressive cognitive decline. No fever.
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There are diffuse FLAIR hyperintense white matter signal abnormalities in bilateral temporal lobes, and left frontal lobe. These regions demonstrate increase diffusivity on ADC which suggest vasogenic edema. SWI images demonstrate multiple punctate foci of susceptibility in the cortex and juxtacortex due to microhemorrhages.
This case is most consistent with cerebral amyloid angiopathy-related inflammation. Patients are usually elderly and tend to present with subacute fatigue, confusion, and cognitive decline. Blood and CSF evaluation including infectious and inflammatory markers are often normal. Development of inflammatory changes in patients with CAA is more frequent in those with the APOE ε4 genotype. Treatment is with high dose steroids and patients usually improve.
- Moussaddy A et al. Inflammatory Cerebral Amyloid Angiopathy, Amyloid-β–Related Angiitis, and Primary Angiitis of the Central Nervous System Similarities and Differences. Stroke. 2015;46:e210-e213.
- Savoiardo M et al. Case 159: Cerebral Amyloid Angiopathy–related Inflammation. Radiology 2010. 256(1).