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Follow-up exam on sixty-year-old woman.

Contributed from the case records of the 
Indiana University Department of Radiology

History:  Follow-up exam on sixty-year-old woman.
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Which choice best characterizes the salient abnormality?

Acute hemorrhageVenous malformationArteriovenous malformationNodular parenchymal enhancmentParasitic cystic lesions
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Follow-up exam on sixty-year-old woman.



Show below is a Susceptibility Weighted Imaging (SWI) image. Before going to the next page, can you derive a differential diagnosis?

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Follow-up exam on sixty-year-old woman.

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Findings:  There are nodular-linear, enhancing lesions seen in the left frontal and parieto-occipital periventricular white matter. These lesions are most extensive in the left parieto-occipital region. There is susceptibility artifact in the left parieto-occipital region on SWI.


Differential diagnosis:

  • Capillary teleangiectasias
  • Multiple cavernous malformations
  • Cerebral amyloidosis
  • Hypertensive microhemorrhages
Diagnosis:  Cerebral amyloidosis
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Follow-up exam on sixty-year-old woman.


Key points:

  • Amyloidosis is caused by excessive extracellular deposition of beta-amyloid
  • Common clinical presentation of cerebral involvement is normotensive patient with cognitive impairment
  • Natural history often shows multiple, recurrent hemorrhages and progressive cognitive decline
  • Cerebral amyloidosis causes up to 20% of primary ICH in patients greater than 60
  • At autopsy, amyloid is found in 82-88% of patients with Alzheimer's disease

References: 

  1. StatDX Cerebral Amyloid Disease by Bronwyn Hamilton. 2011
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Follow-up exam on sixty-year-old woman.


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