Amyloid angiopathy with inflammation
This case highlights several imaging features of cerebral amyloid angiopathy, namely micro-hemorrhages, superficial siderosis, infarcts and amyloid related inflammation.
Amyloid related hemorrhage (ARIA-H) has several manifestations:
- micro-hemorrhages, typically sub-cortical in distribution, correlating with disease progression and cognitive impairment
- lobar hematoma, in the same distribution as micro-hemorrhages
- sub-arachnoid hemorrhage, typically at the vertex and often associated clinically with seizures and/or TIA like symptoms
- superfical siderosis, the result of sub-arachnoid hemorrhage, frequently at cerebral vertex, rarely in the posterior fossa
Amyloid related inflammation with edema (ARIA-E):
- is a form of vasculitis
- may be associated with headache, cognitive decline and seizures
- manifests on imaging as confluent white matter T2 signal change, possibly involving cortex and with mass effect
- is potentially treatable - may respond to immunosuppression
Infarcts in patients with cerebral amyloid angiopathy are increasingly recognized as a manifestation of the disease. They probably reflect occlusive arteriopathy, and may be clinically silent.