open access

Vol 52, No 2 (2018)
Case reports
Submitted: 2017-08-04
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Cerebral amyloid angiopathy-related inflammation – A case report presenting diagnostic difficulties

Cecylia Rajczewska-Oleszkiewicz, Agnieszka Cyganek, Anna Stadnik, Dorota Dziewulska
DOI: 10.1016/j.pjnns.2017.12.014
·
Neurol Neurochir Pol 2018;52(2):298-305.

open access

Vol 52, No 2 (2018)
Case reports
Submitted: 2017-08-04

Abstract

We describe an 86-year-old woman with a history of hypertension who presented sudden disturbances of consciousness and left hemiparesis. Brain magnetic resonance imaging (MRI) revealed diffused hyperintensive changes on T2-weighted images localized subcortically in the white matter of both cerebral hemispheres, corresponding to acute vasogenic edema, causing moderate mass effect. Posterior reversible encephalopathy syndrome was initially diagnosed. After implementation of anti-edema intravenous steroid treatment and hypotensive therapy the symptoms began to retire, till the total regression. The successive hospitalizations took place two and eight months later due to the occurrence of seizures, motor deficits and the development of mild cognitive impairment. Brain MRI revealed progression of the white matter changes and diffused subcortical microhemorrhages. Each time pulse steroid therapy was implemented and the symptoms improved significantly after several days. Chronic oral steroid treatment resulted in the stabilization of neurological status. The long-term observation of clinical symptoms, remission after immunosuppressive therapy and white matter changes with subcortical microhemorrhages in brain MRI leaded to the diagnosis of cerebral amyloid angiopathy-related inflammation.

Abstract

We describe an 86-year-old woman with a history of hypertension who presented sudden disturbances of consciousness and left hemiparesis. Brain magnetic resonance imaging (MRI) revealed diffused hyperintensive changes on T2-weighted images localized subcortically in the white matter of both cerebral hemispheres, corresponding to acute vasogenic edema, causing moderate mass effect. Posterior reversible encephalopathy syndrome was initially diagnosed. After implementation of anti-edema intravenous steroid treatment and hypotensive therapy the symptoms began to retire, till the total regression. The successive hospitalizations took place two and eight months later due to the occurrence of seizures, motor deficits and the development of mild cognitive impairment. Brain MRI revealed progression of the white matter changes and diffused subcortical microhemorrhages. Each time pulse steroid therapy was implemented and the symptoms improved significantly after several days. Chronic oral steroid treatment resulted in the stabilization of neurological status. The long-term observation of clinical symptoms, remission after immunosuppressive therapy and white matter changes with subcortical microhemorrhages in brain MRI leaded to the diagnosis of cerebral amyloid angiopathy-related inflammation.

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Keywords

Cerebral amyloid angiopathy-related inflammation, Posterior reversible encephalopathy syndrome, Recurring cerebral amyloid angiopathy-related inflammation

About this article
Title

Cerebral amyloid angiopathy-related inflammation – A case report presenting diagnostic difficulties

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 52, No 2 (2018)

Pages

298-305

DOI

10.1016/j.pjnns.2017.12.014

Bibliographic record

Neurol Neurochir Pol 2018;52(2):298-305.

Keywords

Cerebral amyloid angiopathy-related inflammation
Posterior reversible encephalopathy syndrome
Recurring cerebral amyloid angiopathy-related inflammation

Authors

Cecylia Rajczewska-Oleszkiewicz
Agnieszka Cyganek
Anna Stadnik
Dorota Dziewulska

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