Probable Cerebral Amyloid Angiopathy-Related Inflammation Presenting as an Incidental MRI Finding in an Elderly
Tatsuya Tanaka1, Takashi Muto2, Taku Goto3
1Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Narita, JPN.
Abstract:
Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a rare but treatable cause of subacute cognitive decline and neurological dysfunction, particularly in the elderly. We report the case of an 88-year-old woman with mild dementia who was independent in her activities of daily living. She presented after minor head trauma, and brain MRI revealed multiple cerebral microbleeds in the bilateral cortices, cerebellum, and thalamus, along with diffuse fluid-attenuated inversion recovery (FLAIR) hyperintensities, suggestive of probable CAA-ri. Given the absence of symptoms, a strategy of close observation was initially adopted. However, two months later, she developed decreased appetite and gait instability, followed by a transient loss of consciousness at three months, necessitating hospitalization. During admission, she subsequently developed disuse syndrome, resulting in discharge to a nursing facility. Follow-up MRI at six months showed resolution of the prior FLAIR hyperintensities but revealed prominent medial temporal lobe atrophy, supporting the diagnosis of probable CAA-ri. This case underscores that even in asymptomatic patients with significant MRI findings consistent with CAA-ri, there is a considerable risk of neurological deterioration and functional decline. While some mild cases may experience spontaneous resolution, the presence of widespread edema and multiple microbleeds may necessitate early immunosuppressive intervention, even if the patient is asymptomatic. The clinical silence of asymptomatic CAA-ri should not lead to an underestimation of its potential for progression. A timely assessment of risk and intervention may be crucial to prevent irreversible neurological and functional impairment.
Insights
Cerebral amyloid angiopathy-related inflammation (CAA-ri) can cause cognitive decline. Even asymptomatic cases risk neurological deterioration, highlighting the need for timely intervention to prevent irreversible impairment.
Area of Science:
- Neurology
- Neuroinflammation
- Geriatric Medicine
Background:
- Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a rare, treatable cause of subacute cognitive decline and neurological dysfunction.
- It predominantly affects the elderly population, presenting a diagnostic challenge due to its variable clinical manifestations.
Observation:
- An 88-year-old woman with mild dementia and independence presented with minor head trauma.
- Brain MRI revealed microbleeds and FLAIR hyperintensities, suggesting probable CAA-ri.
- Initially asymptomatic, she later developed appetite loss, gait instability, and transient loss of consciousness, requiring hospitalization.
Findings:
- Follow-up MRI showed resolution of FLAIR changes but prominent medial temporal lobe atrophy, confirming probable CAA-ri.
- This case demonstrates significant risk of neurological deterioration and functional decline even in initially asymptomatic CAA-ri patients.
- Widespread edema and microbleeds may indicate a need for early immunosuppressive therapy.
Implications:
- Asymptomatic CAA-ri carries a substantial risk of progression and irreversible impairment.
- Early risk assessment and intervention are crucial for managing CAA-ri.
- Clinical vigilance is essential, as the 'clinical silence' of CAA-ri can mask its progressive nature.
Related Concept Videos
01:17Hemorrhagic Stroke l: Introduction
01:19Encephalitis l: Introduction
01:26Brain Abscess l: Introduction
01:22Cerebral Edema ll: Pathophysiology
01:29Alzheimer Disease l: Introduction
01:22Dementia l: Introduction