Headache
Language disturbances Vision changes
Seizures
Palinopsia: Persistence of a visual image after removing the stimulus (occasionally related to
focal seizures)
Optic ataxia: Impairment of visually-guided
reaching
A 55-year-old woman with recurrent episodes of:
Differential diagnosis:
Cerebral amyloid angiopathy-related inflammation
Patient treatment and outcome Posterior reversible
encephalopathy syndrome CNS vasculitis
Asymmetric white matter
hyperintensities involving U-fibers
Enlarged
perivascular spaces Microhemorrhages
Reversible cerebral
vasoconstriction syndrome Autoimmune or
inflammatory disorder
Diagnosis and Treatment of
Cerebral Amyloid Angiopathy- Related Inflammation
Multifocal process involving occipital or
parieto-occipital and frontal regions
Thick and hyalinized leptomeningeal and cortical vessel walls Strongly positive for ß-amyloid
Immunosuppressive therapy: Intravenous solumedrol 1 g daily for 5 days followed by prednisone 60 mg daily, tapered to discontinuation over 12 weeks Levetiracetam 2,000 mg and lacosamide 200 mg, both twice daily
The patient remained seizure-free Marked improvement in brain MRI Mycophenolate 1,000 mg twice daily
As most patients respond to IV steroid therapy, correct diagnosis of cerebral amyloid angiopathy-related
inflammation is critical to achieve favorable clinical outcomes
Radiologic findings
Immuno-histochemical staining
