[A case of intra-axial multiple cavernous angiomas, presented with dementia and cerebellar signs]

We reported a case of intra-axial multiple cavernous angiomas, presented with dementia and cerebellar signs. The patient, a right-handed 73-year-old woman, showed gait disturbances, tremor increased while writing and hypoactivity at the age of 71. Treatment with 1-dopa was not effective. At the age of 73, she was diagnosed as having intra-axial multiple cavernous angiomas on the gradient echo MRI study, which demonstrated large numbers of small low density areas (small dots) in the cerebellar cortex and moderate numbers of those in the cerebral cortices. Those small dots were not detected in the basal ganglia, the brain stem, and increased the thalamus. She clinically showed cerebellar signs, such as dysmetria, adiadochokinesia, and tremor worsening in the course of writings, in additions to the constructural apraxia, disturbances of writing, and severe perseverations. Those symptoms slightly fluctuated. However, she did not show any character changes. The results of Wisconsin card sorting test and Trial making test A were different from those usually seen in dementia with multiple infarctions in the cerebral white matters and basal ganglia. Although her cerebellar signs are considered to be due to numerous small dots in the cerebellar cortex, her parietal symptoms could not be understood by slight parietal changes such as hypoperfusions of SPECT, cerebral small dots, and infarctions in the white matters. We speculated that, by interactions between the cerebellar dysfunctions and slight parietal dysfunctions, she developed the parietal symptoms described above, which differed from dementia or Parkinsonism due to multiple cerebral infarctions, and which were characterized by slight fluctuations and alleviations with habituation.