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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
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Multiple cerebral microinfarcts: an uncommon presentation of Cerebral Amyloid Angiopathy-related inflammation

Aikaterini Theodorou1, Athanasios Tsibonakis1, Ioannis S Pateras2

  • 1Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Neurological Research and Practice
|June 21, 2023
PubMed
Abstract

Insights

Cerebral Amyloid Angiopathy-related inflammation (CAA-ri) is a rare condition. Early diagnosis, even with atypical MRI findings, and prompt steroid treatment are crucial for improving outcomes in CAA-ri patients.

Area of Science:

  • Neurology
  • Neuroimaging
  • Pathology

Background:

  • Cerebral Amyloid Angiopathy-related inflammation (CAA-ri) is a rare subset of Cerebral Amyloid Angiopathy (CAA).
  • High-resolution MRI aids CAA-ri diagnosis, but brain biopsy remains essential for atypical cases.
  • CAA-ri diagnosis is increasingly recognized due to advanced neuroimaging techniques.

Discussion:

  • A 71-year-old male with hypertension presented with neurological symptoms.
  • Brain MRI showed microinfarcts and leptomeningeal enhancement, leading to a brain biopsy.
  • Histology confirmed amyloid deposition, meeting criteria for probable CAA-ri.

Key Insights:

  • Brain biopsy is crucial for diagnosing CAA-ri with atypical neuroimaging findings like acute microinfarcts.
  • Prompt treatment with steroids (methylprednisolone) led to clinical and radiological improvement.
  • Follow-up MRI showed increased microbleeds, confirming CAA-ri neuroimaging criteria.

Outlook:

  • Vigilance in clinical neurology is key for timely CAA-ri detection.
  • Early diagnosis and treatment significantly improve prognosis in CAA-ri.
  • This case underscores the diagnostic utility of brain biopsy in complex CAA-ri presentations.
Keywords:
Brain biopsyCAA-riCase ReportCerebral microinfarctsMRI

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