Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of cerebral amyloid angiopathy with reversible white matter lesions and multiple cerebral microbleeds

Yasushi Hosoi, M.D.1), Tsuyoshi Uchiyama, M.D.1), Mari Yoshida, M.D.2), Daisuke Takechi, M.D.3),Takako Shimizu, M.D.1), Toshihiko Ohashi, M.D.1) and Yoshiro Otsuki, M.D.4)

1)Department of Neurology, Seirei Hamamatsu General Hospital
2)Institute for Medical Science of Aging, Aichi Medical University
3)Department of Internal Medicine, Seirei Hamamatsu General Hospital
4)Department of Pathology, Seirei Hamamatsu General Hospital

A 59-year-old woman presented with a 7-year history of headache. She showed no neurological abnormality. T2 weighted magnetic resonance (MR) images showed a hyperintense signal in the white matter in the bilateral parieto-occipital lobe without abnormal enhancement. A small amount of prednisolone was administered for rheumatoid arthritis. After prednisolone was discontinued, the T2 weighted images showed an expansion of the hyperintense signal lesions seen in the white matter, and T2* weighted image showed multiple foci of petechial bleeding in the cortex and subcortex of the bilateral occipital lobe. A brain biopsy specimen from the right occipital lobe revealed deposition of amyloid in the subarachnoidal and cortical vessel walls and transmural infiltration of a few lymphocytes, eosinophils, and giant histiocytes. Subsequently the patient was diagnosed with central nervous system vasculitis associated with cerebral amyloid angiopathy (CAA). After 5 months, the T2 weighted images showed a remarkable regression of the hyperintense signal lesions in the white matter of the bilateral parietooccipital lobe without the administration of any maintenance immunosuppressive agents. However, T2* weighted image showed an increase of multiple cortico-subcortical foci of petechial bleeding. Her headache did not improve during the illness. Thus, we should consider the diagnosis of CAA when patients present with reversible white matter lesions and multiple cerebral microbleeds simultaneously.
Full Text of this Article in PDF (776K)

(CLINICA NEUROL, 52: 90|95, 2012)
key words: cerebral amyloid angiopathy, reversible white matter lesion on magnetic resonance image, brain biopsy, granulomatous angiitis of the central nervous system

(Received: 20-Jun-11)