Cerebral amyloid angiopathy
Demented patient, presented with acute neurological symptoms. Patient is normotensive.
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T1 and T2WI show multiple peripheral foci of cerebral hemorrhage which are T1 bright and variably T2 isointense or bright, representing a mixture of acute/early subacute bleeds.
T2*WI shows numerous additional foci of punctate susceptibility artifact ("black dots"), consistent with angiopathic microbleeds.
Top differential diagnoses for multifocal "black dots" on T2/T2* MR include various etiologies of small hemorrhages:
- hypertensive microhemorrhages
- ischemic stroke with microhemorrhages
- multiple cavernous malformations (type 4)
- diffuse axonal injury
- hemorrhagic metastases
However, each of the above mentioned differential diagnoses has different clinical scenario and other supportive imaging features.