A 74-year-old woman was admitted to our hospital with a history of episodes of left-sided hemiparesis and numbness for few minutes. A brain MRI showed cortical subarachnoid blood and diffuse cortical microbleeds, compatible with a diagnosis of cerebral amyloid angiopathy, according to modified Boston criteria11. Greenberg SM, Charidimou A. Diagnosis of cerebral amyloid angiopathy - Evolution of the Boston criteria. Stroke. 2018 Feb;49(2):491-7. https://doi.org/10.1161/STROKEAHA.117.016990
https://doi.org/10.1161/STROKEAHA.117.01...
. Other possible causes of the MRI findings, such as coagulopathy and traumatic brain injury, were excluded.
Cerebral amyloid angiopathy, a common cause of lobar hemorrhage in older patients, can also present with transient focal neurological episodes, which are sometimes known as ‘amyloid spells’. These are stereotyped, recurrent, transient episodes of numbness or weakness and may mimic a transient ischemic attack11. Greenberg SM, Charidimou A. Diagnosis of cerebral amyloid angiopathy - Evolution of the Boston criteria. Stroke. 2018 Feb;49(2):491-7. https://doi.org/10.1161/STROKEAHA.117.016990
https://doi.org/10.1161/STROKEAHA.117.01...
,22. Pontes-Neto OM, Auriel E, Greenberg SM. Advances in our Understanding of the Pathophysiology, Detection and Management of Cerebral Amyloid Angiopathy. Eur Neurol Rev. 2012;7(2):134-9. https://doi.org/10.17925/ENR.2012.07.02.134
https://doi.org/10.17925/ENR.2012.07.02....
,33. Charidimou A, Law R, Werring DJ. Amyloid “spells” trouble. Lancet. 2012 Nov;380(9853):1620. https://doi.org/10.1016/S0140-6736(12)61333-6
https://doi.org/10.1016/S0140-6736(12)61...
,44. Nadarajan V, Perry RJ, Johnson J, Werring DJ. Transient ischaemic attacks: mimics and chameleons. Pract Neurol. 2014 Feb;14(1):23-31. https://doi.org/10.1136/practneurol-2013-000782
https://doi.org/10.1136/practneurol-2013...
,55. Charidimou A, Peeters A, Fox Z, Gregoire SM, Vandermeeren Y, Laloux P, et al. Spectrum of transient focal neurological episodes in cerebral amyloid angiopathy: multicentre magnetic resonance imaging cohort study and meta-analysis. Stroke. 2012 Sep;43(9):2324-30. https://doi.org/10.1161/STROKEAHA.112.657759
https://doi.org/10.1161/STROKEAHA.112.65...
.
References
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1Greenberg SM, Charidimou A. Diagnosis of cerebral amyloid angiopathy - Evolution of the Boston criteria. Stroke. 2018 Feb;49(2):491-7. https://doi.org/10.1161/STROKEAHA.117.016990
» https://doi.org/10.1161/STROKEAHA.117.016990 -
2Pontes-Neto OM, Auriel E, Greenberg SM. Advances in our Understanding of the Pathophysiology, Detection and Management of Cerebral Amyloid Angiopathy. Eur Neurol Rev. 2012;7(2):134-9. https://doi.org/10.17925/ENR.2012.07.02.134
» https://doi.org/10.17925/ENR.2012.07.02.134 -
3Charidimou A, Law R, Werring DJ. Amyloid “spells” trouble. Lancet. 2012 Nov;380(9853):1620. https://doi.org/10.1016/S0140-6736(12)61333-6
» https://doi.org/10.1016/S0140-6736(12)61333-6 -
4Nadarajan V, Perry RJ, Johnson J, Werring DJ. Transient ischaemic attacks: mimics and chameleons. Pract Neurol. 2014 Feb;14(1):23-31. https://doi.org/10.1136/practneurol-2013-000782
» https://doi.org/10.1136/practneurol-2013-000782 -
5Charidimou A, Peeters A, Fox Z, Gregoire SM, Vandermeeren Y, Laloux P, et al. Spectrum of transient focal neurological episodes in cerebral amyloid angiopathy: multicentre magnetic resonance imaging cohort study and meta-analysis. Stroke. 2012 Sep;43(9):2324-30. https://doi.org/10.1161/STROKEAHA.112.657759
» https://doi.org/10.1161/STROKEAHA.112.657759
Publication Dates
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Publication in this collection
20 Jan 2020 -
Date of issue
Jan 2020
History
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Reviewed
23 Feb 2019 -
Received
01 May 2019 -
Accepted
02 May 2019