Cerebral amyloid angiopathy with multifocal lobar hemorrhages

Case contributed by Dr Mohammad A. ElBeialy

Presentation

80 years old normotensive patient with right sided weakness and disturbed level of consciousness.

Patient Data

Age: 80 years
Gender: Female

Multiple left occipital as well as parietal and high posterior frontal hemorrhagic mass lesions are seen with the largest is about 3.5 X 2.5 cm. They demonstrate predominately hyperintense T1 and T2 signal with iso- to hypointense core. The lesions show blooming in GRE sequence. They show no evident post-contrast enhancement. They are surrounded by perifocal vasogenic brain edema with some compression of the occipital horn and trigone of the left lateral ventricle.  A tiny few millimeteric lesion with GRE blooming is seen in the right parietal lobe.

Mild dilatation of the ventricular system with patchy T2/FLAIR hyperintense foci at the periventricular and deep white matter.

Widened extra-axial CSF spaces; no extra-axial collection.

Normal sellar region and posterior fossa.

Mild atherosclerotic changes of the cerebral arteries with mild irregularity. Otherwise normal signal and caliber of the cerebral arteries with no occluded segment or significant stenosis.

No aneurysmal dilatation or A-V malformation.

Attenuated right vertebral artery, otherwise, normal vertebro-basilar system.

Case Discussion

Bilateral; predominately left cerebral subacute hemorrhagic, non enhancing mass lesions; these lobar hemorrhages are suggestive of amyloid angiopathy; lack of enhancement makes hemorrhagic metastatic deposits much less likely possibility. Consider amyloid angiopathy in normotensive elderly patients with multifocal non-enhancing lobar hemorrhage.

Atrophic brain changes with periventricular arteriosclerotic leucoencephalopathy.  Mild atherosclerotic changes of the cerebral arteries, with no other significant abnormality.

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Case information

rID: 23474
Published: 18th Jun 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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