Case of the Day(sm)

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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.

Click these images to enlarge them.

Which choice best characterizes the salient abnormality?

Acute hemorrhage Venous malformation Arteriovenous malformation Nodular parenchymal enhancment Parasitic cystic lesions

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Case of the Day(SM) Copyright

Case of the Day(sm)

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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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Case of the Day(SM) Copyright

Case of the Day(sm)

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

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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Case of the Day(SM) Copyright

Case of the Day(sm)

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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

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