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Hypertensive microangiopathy

Case contributed by Abdulmajid Bawazeer
Diagnosis probable

Presentation

Hypertensive and diabetic patient came with new onset of left lower limb weakness.

Patient Data

Age: 60 years
Gender: Male
mri

Diffuse bilateral blooming artefacts involving both cerebellar hemispheres, basal ganglia, thalamus, brain stem and cerebellar hemispheres.

Bilateral periventricular confluent high signal intensity seen on T2 and FLAIR images with no restriction diffusion or mass-effect suggesting small vessel disease.

Small area of restriction diffusion seen in the right periventricular white matter keeping with acute infarction.

Case Discussion

The blooming artefact distribution pattern (microhemorrhages) is strongly associated with hypertensive microangiopathy other differentials are cerebral amyloid angiopathy (usually peripheral) and multiple cavernoma syndrome. 

 

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