Cerebral amyloid angiopathy
Disturbed level of consciousness and focal neurological symptoms with history of declining cognitive performance. No history of elevated blood pressure.
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- multiple punctate hypointense lesions are visible only on SWI in a cortico-medullary distribution, largely sparing the basal ganglia, eliciting blooming artifact, without mass effect or edema, likely representing multiple lobar cerebral microhemorrhages
- leukoencephalopathy with a periventricular predilection and global cerebral atrophy are evident
- Multiple infarcts of different chronological ages, including acute insults
The differential diagnosis for this case would include:
- multiple cavernomas, less likely due to lesion locations and patient's age
- hypertensive microangiopathy, less likely due to lesion locations and patient's normotensive state
- diffuse axonal injury, less likely due to no history of trauma
The established leukoencephalopathy, infarcts and brain atrophy all likely have a part in the patient's current presentation.