Vascular Parkinsonism and Cognitive Impairment without Lobar Hemorrhage related to Cerebral Amyloid Angiopathy

Fj Ros Forteza

doi:10.18314/abne.v2i1.1634

Abstract

Clinical recognition of Cerebral Amyloid Angiopathy is difficult due to clinical and imagiological heterogeneity. The Modified Boston Criteria for diagnosis of ‘probable Cerebral Amyloid Angiopathy’ pathologically validated in 2010 had an increase in sensitivity with only a modest decrease in specificity. Following case illustrates a diagnostic challenge to an elderly patient with vascular risk factors, neurodegenerative symptomatology with multiple cerebral vascular lesions (ischemic and hemorrhagic, without lobar hemorrhage). The use of a non-invasive amyloid marker would be useful in atypical clinical courses of patients with Cerebral Amyloid Angiopathy.

Highlights

Case PresentationCerebral Amyloid Angiopathy (CAA) is an entity of unknown origin that it is characterized by the deposition of material amyloid in the walls of the cerebral vessels and leptomeninges
Case PresentationCerebral Amyloid Angiopathy (CAA) is typical of elderly people, the average age of cerebral hemorrhage is the 7th decade, it is related to the ApoE and CR1 genes, it does not have sex predominance, and the risk factors of hemorrhage in the CAA are ischemic stroke previous, alcoholism and drugs
The brain lesions can be lobar hemorrhage, microbleeds, subarachnoid haemorrhage (SAH), superficial cortical siderosis, corticosubcortical microinfarcts and leukoaraiosis, according to Mateu AM, 2014

Summary

Introduction

Cerebral Amyloid Angiopathy (CAA) is an entity of unknown origin that it is characterized by the deposition of material amyloid in the walls of the cerebral vessels and leptomeninges. Three months after the clinical picture, the patient performed a brain MRI (Figure 1) that revealed multiple lacunar infarcts of white matter (WM) and gray matter (GM) in both cerebral hemispheres and brainstem, and infarction of the right posterior-inferior cerebellar artery. Six months after the clinical debut, episodes of several min (3-4) of duration were observed at home with ocular deviation, facial pallor, drooling, without involuntary movements of limbs, remaining inanimate, without urinary incontinence. He had a Mini-Mental State Examination score suggesting mild cognitive impairment (score 26: orientation 9, registration 3, attention and calculation 5, recall 2, language 6 and construction 1), without hallucinatory activity or behavior alteration.

Discussion

Findings

Conflict of interests