Case 232: Amyloid β-related Angiitis

History A 78-year-old woman presented to a community hospital after an unwitnessed fall at her nursing home. Initial head computed tomography (CT) performed in the emergency department showed vasogenic edema in the right temporal parietal region, which prompted her transfer to our institution for additional work-up. Further history taking revealed recurrent transient motor and sensory transient ischemic attack-like symptoms over the preceding weeks. She denied having a fever or night sweats. There was no history of infection, bleeding, immunodeficiency, intravenous drug use, alcohol or tobacco abuse, malignancy, or genetic disorders. Her medical history included memory impairment and a left posterior cerebral artery territory infarction. She was not known to have any systemic inflammatory disorder. Physical examination findings at presentation were noncontributory. She was not taking any anticoagulants or immunosuppressive medication. Pertinent hematologic laboratory investigations revealed a white blood cell count of 6.7 × 10(9), a C-reactive protein level of 29 mg/L (276.2 nmol/L) (normal value, <10 mg/L [95.2 nmol/L]), and an erythrocyte sedimentation rate of 35 mm per hour (normal value, 0-10 mm per hour). Shortly after this patient was admitted to our institution, she had a generalized tonic-clonic seizure. Magnetic resonance (MR) imaging of the brain was performed the next day.