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Cerebral amyloid angiopathy-related inflammation – A case report presenting diagnostic difficulties
- Department of Neurology, Medical University of Warsaw, 8 Kondratowicza str, 03-242 Warsaw, Poland
- 1 st Department of Radiology, Medical University of Warsaw, Chałubińskiego str 5, 02-004 Warsaw, Poland
- Department of Experimental and Clinical Neuropathology, Mossakowski Medical Research Center, Polish Academy of Science, Warsaw, Poland
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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.
Keywords
Cerebral amyloid angiopathy-related inflammation, Posterior reversible encephalopathy syndrome, Recurring cerebral amyloid angiopathy-related inflammation
Title
Cerebral amyloid angiopathy-related inflammation – A case report presenting diagnostic difficulties
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
298-305
Published online
2018-01-06
Page views
317
Article views/downloads
551
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