Presentation
Frontal dysexecutive symptoms.
Patient Data
Very extensive predominately peripherally located punctate susceptibility-weighted signal loss regions are demonstrated, with a particularly dense cluster in the left parietal lobe which is associated with increased T2 signal involving both the subcortical white matter and the cortex. These features are consistent with inflammatory cerebral amyloid angiopathy.
Superimposed upon these changes is extensive chronic small vessel ischemic change with modest fairly generalized volume loss, more pronounced in the frontal lobes. Chronic small vessel ischemic change is also seen involving the pons. The hippocampi appear small bilaterally, although this is not borne out on morphometry.
Conclusion: inflammatory cerebral amyloid angiopathy.
Case Discussion
The presence of peripherally distributed microhemorrhages associated with edema is characteristic of inflammatory cerebral amyloid angiopathy. The diagnosis is, nonetheless, presumptive.
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