Presentation
Patient presents with cognitive decline and seizures
Patient Data
MRI of the brain demonstrates multiple diffuse bilateral cortical and subcortical microhemorrhages though with greater involvement of the left cerebral hemisphere. There is associated asymmetric confluent lobar edema involving the left parietal, occipital, and temporal lobes. The edema corresponds to the densest areas of microhemorrhages. There is associated regional mass effect with effaced cortical sulci and partial effacement of the left lateral ventricle. On post contrast imaging, there is leptomeningeal enhancement overlying the areas of lobar edema.
Case Discussion
This case demonstrates the typical appearance of inflammatory cerebral amyloid angiopathy evidenced by asymmetric lobar edema corresponding to the areas of cortical and subcortical microhemorrhage. The patient was not on treatment with amyloid lowering therapies to suggest amyloid-related imaging abnormalities (ARIA).
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