Cerebral amyloid angiopathy related lobar hemorrhage
Patients presented with acute neurological deterioration and decreased GCS. History of cognitive impairment for last few weeks with history of left side paresthesia for two days.
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Acute lobar hemotoma (isointense on T1WI and hypointense on T2WI with diffusion restriction and blooming artifact on T2* GRE sequence) is noted in the right parietal cortical-subcortical location involving the post central gyrus.
Grade III leukoencephalopathy (large confluent, symmetrical T2WI and FLAIR hyper intensities involving deep white matter and centrum semiovale (sparing the U fibers) noted probably due to microangiopathic changes secondary to amyloid-ß peptide deposition in the arterial walls.
T2* GRE images show multiple small foci of susceptibility blooming in the bilateral cerebral cortical and subcortical locations.
The Boston criteria for probable cerebral amyloid angiopathy are:
- appropriate clinical history
- Age ≥55 years
- MR imaging: Multiple cortical-subcortical hematomas, which may be of varying ages and sizes, with no other clinical or radiologic cause of hemorrhage.
Case contributed by: Dr. Najibullah Rasouly and Dr. Hidayatullah Hamidi