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Cerebral amyloid angiopathy

Case contributed by Mohammad Farghali Ali Tosson
Diagnosis almost certain

Presentation

Stroke.

Patient Data

Age: 70 years old
Gender: Male
mri

An intra-axial right occipitoparietal hemorrhage exhibiting hyperintense signal on T1W, T2WI and in FLAIR. No perilesional edema and no significant mass effect.

Innumerable foci of blooming artefact in keeping with blood products are present in the supra and infratentorial brain.

Multiple periventricular and right basal ganglia small focal abnormal signal intensities that are isointense at T1WI, but hyperintense at T2WI and FLAIR with no diffusion restriction, suggestive of chronic small vessel ischaemiat

 No mass effect or perilesional edema .

Case Discussion

The peripheral distribution of these microhemorrhages is very characteristic of cerebral amyloid angiopathy with little if any viable alternative diagnosis. 

Multiple cavernomas invariably have some blooming artifacts that are larger and visible on other sequences. They do not spare the basal ganglia. 

Miliary hemorrhagic metastases would be expected to also be more random and to have some enhancement and edema.

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