Cerebral amyloid angiopathy-related inflammation

Case contributed by Dr Y. Amy Chen

Presentation

Several months history of headaches and progressive cognitive decline. No fever.

Patient Data

Age: 65 years
Gender: Male

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.

Case Discussion

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.

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Case information

rID: 58270
Published: 12th Feb 2018
Last edited: 13th Feb 2018
Inclusion in quiz mode: Included
Institution: trillium health partners

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