Lateralized Cerebral Amyloid Angiopathy presenting with recurrent Lacunar Ischemic Stroke

Main Article Content

Yi Li
Ayman Al-Salaimeh
Elizabeth DeGrush
Majaz Moonis

Abstract

Here we reported an interesting case of an 84-year-old woman with acute onset of paresis of left arm and paresthesia of left face and arm. The symptoms resolved within two hours. She also had a similar prior episode two weeks ago with only left arm paresthesia. Her MRI revealed different stages of lacunar ischemic lesions. Interestingly, the SWAN sequences showed lateralized rather than global multiple microhemorrhages over the right MCA and PCA territory, and the sulcal hyperintensity on FLAIR was also seen with no associated susceptibility effect and minimal enhancement, indicating probable cerebral amyloid angiopathy (CAA) based on Boston Criteria.


It has been acknowledged that the CAA could manifest with certain localization preference. Cerebral microinfarct and white matter disease in CAA have been more often observed in the posterior circulation territory, however the restricted lateralization reported in our case has not been seen. Since CAA is often diagnosed when the characteristic MRI findings are picked up incidentally, recognizing this as a potential “TIA mimic” will be important for guiding treatment due to its higher risk of bleeding. In summary, this case highlights that the CAA could present as restricted lateralized lesions and occur as transient neurologic deficits, which to our knowledge has not be reported before. Recognition of it as a potential manifestation of CAA will be valuable in the clinical diagnosis process.

Article Details

Li, Y., Al-Salaimeh, A., DeGrush, E., & Moonis, M. (2017). Lateralized Cerebral Amyloid Angiopathy presenting with recurrent Lacunar Ischemic Stroke. Journal of Neuroscience and Neurological Disorders, 1(1), 029–032. https://doi.org/10.29328/journal.jnnd.1001005
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Copyright (c) 2017 Li Y, et al.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

Knudsen KA, Rosand J, Karluk D, Greenberg SM. Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology. 2001; 56: 537-539. Ref.: https://goo.gl/WjSJnQ

Viswanathan A, Greenberg SM. Cerebral amyloid angiopathy in the elderly. Ann Neurol. 2011; 70: 871-880. Ref.: https://goo.gl/du5nK2

Masuda J, Tanaka K, Ueda K, Omae T. Autopsy study of incidence and distribution of cerebral amyloid angiopathy in Hisayama, Japan. Stroke. 1988; 19: 205-210. Ref.: https://goo.gl/i92uDE

Morton-Bours EC, Skalabrin EJ, Albers GW. Cerebral amyloid angiopathy with unilateral hemorrhages, mass effect, and meningeal enhancement. Neurology. 1999; 53: 233-234. Ref.: https://goo.gl/jchJeP

Lee SH, Kim SM, Kim N, Yoon BW, Roh JK. Cortico-subcortical distribution of microbleeds is different between hypertension and cerebral amyloid angiopathy. J Neurol Sci. 2007; 258: 111-114. Ref.: https://goo.gl/oZaA8o

Van Veluw SJ, Charidimou A, Van der Kouwe AJ, Lauer A, Reijmer YD, et al. Microbleed and microinfarct detection in amyloid angiopathy: a high-resolution MRI-histopathology study. Brain. 2016; 139: 3151-3162. Ref.: https://goo.gl/hz1YPf

Kovari E, Herrmann FR, Gold G, Hof PR, Charidimou A. Association of cortical microinfarcts and cerebral small vessel pathology in the ageing brain. Neuropathol Appl Neurobiol. 2016. Ref.: https://goo.gl/Gd4LNi

Thanprasertsuk S, Martinez-Ramirez S, Pontes-Neto OM, Ni J, Ayres A, et al. Posterior white matter disease distribution as a predictor of amyloid angiopathy. Neurology. 2014; 83: 794-800. Ref.: https://goo.gl/X8jzJ9

Scolding NJ, Joseph F, Kirby PA, Mazanti I, Gray F, et al. Abeta-related angiitis: primary angiitis of the central nervous system associated with cerebral amyloid angiopathy. Brain. 2005; 128: 500-515. Ref.: https://goo.gl/h69HHe

Malhotra K, Magaki SD, Cobos Sillero MI, Vinters HV, Jahan R, et al. Atypical case of perimesencephalic subarachnoid hemorrhage. Neuropathology. 2017; 37: 272-274. Ref.: https://goo.gl/GJ5hwT

Salvarani C1, Hunder GG, Morris JM, Brown RD Jr, Christianson T, et al. Aβ-related angiitis: comparison with CAA without inflammation and primary CNS vasculitis. Neurology. 2013; 81: 1596-603. Ref.: https://goo.gl/Cd51Ws

Moussaddy A, Levy A, Strbian D, Sundararajan S, Berthelet F, et al. Inflammatory Cerebral Amyloid Angiopathy, Amyloid-β-Related Angiitis, and Primary Angiitis of the Central Nervous System: Similarities and Differences. Stroke. 2015; 46: e210-213. Ref.: https://goo.gl/QHtBfD

Charidimou A, Peeters A, Fox Z, Gregoire SM, Vandermeeren Y, et al. Spectrum of transient focal neurological episodes in cerebral amyloid angiopathy: multicentre magnetic resonance imaging cohort study and meta-analysis. Stroke. 2012; 43: 2324-2330. Ref.: https://goo.gl/4zknF4

Boulouis G, Charidimou A, Jessel MJ, Xiong L, Roongpiboonsopit D, et al. Small vessel disease burden in cerebral amyloid angiopathy without symptomatic hemorrhage. Neurology. 2017; 88: 878-884. Ref.: https://goo.gl/bXgN8Y