Cerebral amyloid angiopathy presenting as a nonhemorrhagic, infiltrating mass

Area of Science:

• Neurology
• Neuroradiology
• Pathology

Background:

• Cerebral amyloid angiopathy (CAA) is a common cause of non-traumatic intracerebral hemorrhage, particularly in the elderly.
• CAA is characterized by the deposition of amyloid-beta protein in the walls of cerebral arteries.
• While typically associated with hemorrhage, CAA can present with diverse imaging features.

Observation:

• A patient presented with MRI findings suggestive of a unilateral, non-hemorrhagic, infiltrating, intra-axial brain mass.
• The imaging characteristics mimicked a primary or metastatic brain tumor.
• Biopsy confirmed the diagnosis of cerebral amyloid angiopathy.

Findings:

• Cerebral amyloid angiopathy can manifest as an intra-axial mass lesion on magnetic resonance imaging (MRI).
• The lesion was unilateral, non-hemorrhagic, and infiltrating, posing a diagnostic challenge.
• Histopathological examination confirmed the diagnosis of CAA.

Implications:

• This case highlights the importance of considering CAA in the differential diagnosis of intra-axial brain masses, even in the absence of hemorrhage.
• Prompt diagnosis and appropriate management, such as steroid therapy, can lead to significant clinical and radiological improvement.
• Recognizing this rare presentation of CAA can prevent unnecessary aggressive treatments and guide patient management effectively.