État criblé with acute on chronic ischemia and amyloid angiopathy

Case contributed by Dr Chris O'Donnell

Presentation

Dementia with previous left-sided weakness, now worsening. Imaging requested to investigate a possible recent infarction or haemorrhage.

Patient Data

Age: 85
Gender: Female

Widespread periventricular T2 brightening - FLAIR sequence separates into fluid (low signal) in old lacunes and etat criblé, and gliosis in areas of ischemia. Note restricted diffusion and reduced ADC in the right corona radiata and posterior limb of internal capsule = acute infarction. Widespread foci of magnetic susceptibility throughout the brain probably represent sites of old hemorrhage.

Case Discussion

This patient has the full hand of degenerative vascular disease of the brain: widespread old deep (periventricular) ischemic change including lacunes (etat lacunaire), more acute deep infarction and widespread foci of hemosiderin (magnetic susceptibility) indicating sites of microhemorrhage including the brain stem. The brain is atrophic resulting in marked dilatation of the perivascular (Virchow-Robin) spaces causing the appearance of etat criblé (sieve-like state).

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Case information

rID: 35335
Published: 2nd Apr 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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