Magnetic Resonance Imaging Manifestations of Bilateral Cerebral Amyloid Angiopathy-Related Inflammation with Seizures

Abstract

Cerebral Amyloid Angiopathy-related inflammation (CAA-ri) is a distinct subtype of CAA characterized by rapidly progressive cognitive decline, focal deficits, seizures, and headache. It is characterized by vasculitis associated with cerebral amyloid deposition. Differential diagnosis may be challenging due to overlapping symptoms and lack of clear imaging criteria, although CCA-ri is usually responsive to immunosuppressive therapy. We describe an 81-year-old female diagnosed with CAA-ri by Magnetic Resonance Imaging (MRI). Fluid-Attenuated Inversion Recovery (FLAIR) imaging revealed hyperintense lesions in the bilateral temporal and occipital areas, and T2*-weighted gradient echo (T2*-GRE) imaging demonstrated multiple cortical and subcortical hypointensities in the same areas. Furthermore, the findings of T2*-GRE were confirmed by Susceptibility-Weighted Imaging (SWI). In cases of encephalopathy, CAA-ri should be considered in the differential diagnosis, and the presence of microbleeds should be examined using T2*-GRE and (or) SWI MRI.