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Cerebral amyloid angiopathy presenting as nonhemorrhagic diffuse encephalopathy: neuropathologic and neuroradiologic
M Caulo1, D Tampieri, R Brassard
1Department of Neuroradiology, Montreal Neurological Institute of McGill University, Montreal, Canada.
Abstract:
A case of cerebral amyloid angiopathy is presented with MR imaging findings of high intense signal on T2-weighted sequences at the level of the white and gray matter of both hemispheres in the absence of neuroradiologic signs of cerebral hemorrhage. The biopsy specimen revealed deposition of amyloid in the walls of the intracranial arterial branches and focal ischemic changes and gliosis in the gray and white matter. We consider this presentation to be very unusual in patients affected by cerebral amyloid angiopathy.
Insights
This case study highlights unusual MR imaging findings in cerebral amyloid angiopathy (CAA). The findings included high T2-weighted signals in gray and white matter without signs of hemorrhage, differing from typical CAA presentations.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Cerebral amyloid angiopathy (CAA) is a common cause of lobar hemorrhage in the elderly.
- CAA is characterized by amyloid-beta deposition in cerebral arteries, leading to microhemorrhages and white matter changes.
Observation:
- A unique case of CAA presented with high signal intensity on T2-weighted MRI sequences in the gray and white matter of both cerebral hemispheres.
- Crucially, these imaging findings were observed in the absence of any neuroradiologic signs of cerebral hemorrhage.
Findings:
- Biopsy confirmed amyloid deposition within the walls of intracranial arterial branches.
- Focal ischemic changes and gliosis were identified in the gray and white matter, correlating with the observed MRI signals.
Implications:
- This atypical presentation challenges conventional understanding of CAA's imaging characteristics.
- Highlights the importance of considering CAA even with non-hemorrhagic MRI findings, prompting further investigation into diverse CAA manifestations.