ABSTRACT
Cerebral amyloid angiopathy as a cause of recurrent small cortical strokes is under-recognised. These patients need haemosiderin-sensitive MRI to make a diagnosis and intensive antiplatelet treatment is dangerous.
Subject(s)
Brain Infarction/etiology , Cerebral Amyloid Angiopathy/complications , Aged , Aged, 80 and over , Brain Infarction/pathology , Cerebral Amyloid Angiopathy/pathology , Humans , Magnetic Resonance Imaging , Male , NeuroimagingSubject(s)
Diagnostic Errors , Magnetic Resonance Imaging , Neurosyphilis/diagnosis , Temporal Lobe/pathology , Humans , MaleSubject(s)
Angioplasty/economics , Angioplasty/instrumentation , Carotid Artery Diseases/economics , Carotid Artery Diseases/therapy , Centers for Medicare and Medicaid Services, U.S./economics , Health Policy/economics , Insurance, Health, Reimbursement , Stents/economics , Angioplasty/adverse effects , Angioplasty/legislation & jurisprudence , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Evidence-Based Medicine , Humans , Insurance, Health, Reimbursement/legislation & jurisprudence , Patient Selection , Policy Making , Risk Assessment , Risk Factors , United StatesABSTRACT
BACKGROUND AND PURPOSE: Convexity subarachnoid haemorrhage (cSAH) has recently been recognised as a cause of recurrent aura-like symptoms, mimicking transient ischaemic attacks (TIAs). Subarachnoid haemorrhage and recurrent aura-like episodes can occur in patients with cerebral amyloid angiopathy (CAA), which has been the presumed cause in the majority of reported cases. However, this syndrome can occur following cSAH secondary to other conditions, and it is important for clinicians to investigate and manage such patients appropriately. METHOD: Case series. RESULTS: We describe two patients who presented with recurrent stereotyped transient neurological symptoms in the setting of acute cSAH identified on MRI. In one patient, SAH occurred secondary to cerebral venous sinus thrombosis. In the other, SAH was due to extension of a traumatic subdural haematoma. CONCLUSIONS: Conditions other than CAA can cause the clinicoradiological syndrome of cSAH with recurrent TIA-like events. Gradient echo or susceptibility-weighted imaging should be included in the diagnostic work-up of patients presenting with such events. When cSAH is detected, the full differential diagnosis for this should be considered. Aetiologies other than CAA can cause this syndrome and management can vary greatly depending on the underlying cause.
Subject(s)
Epilepsy/diagnosis , Epilepsy/etiology , Subarachnoid Hemorrhage/complications , Aged , Aged, 80 and over , Cerebral Amyloid Angiopathy/diagnosis , Diagnosis, Differential , Epilepsy/pathology , Female , Hematoma, Subdural, Intracranial/complications , Humans , Ischemic Attack, Transient/diagnosis , Male , Sinus Thrombosis, Intracranial/complications , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/pathologyABSTRACT
Reversible cerebral vasoconstriction is a rare and poorly understood syndrome, without clear diagnostic criteria. It has been described in association with multiple disorders, but has only been reported rarely in the setting of carotid artery dissection and, to our knowledge, never before in association with renal artery stenosis.
Subject(s)
Brain/blood supply , Carotid Artery, Internal, Dissection/complications , Renal Artery Obstruction/complications , Vasoconstriction , Adult , Antihypertensive Agents/therapeutic use , Brain/pathology , Carotid Artery, Internal, Dissection/pathology , Cerebrovascular Circulation/drug effects , Cerebrovascular Circulation/physiology , Female , Headache Disorders, Primary/etiology , Humans , Hypertension/complications , Hypertension/drug therapy , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Nimodipine/therapeutic use , Renal Artery Obstruction/pathology , Vasodilator Agents/therapeutic useABSTRACT
The spectrum of central nervous system (CNS) vascular pathology in systemic lupus erythematosus (SLE) includes small vessel vasculopathy, thromboembolism, perivascular lymphocytic infiltration and, rarely, overt transmural vasculitis. We present the case of a patient, who experienced three CNS relapses over total disease duration of 26 years, with otherwise indolent disease. The first two relapses were suspicious of vasculitis and the last was proven at autopsy. The short duration between final relapse onset and death in this SLE CNS vasculitis case was, to our knowledge, unique. Histopathological investigation demonstrated multiple confluent areas of haemorrhage in the medulla due to an acute small vessel leucocytoclastic vasculitis.
Subject(s)
Brain Stem/blood supply , Intracranial Hemorrhages/etiology , Lupus Erythematosus, Systemic/complications , Vasculitis, Central Nervous System/complications , Vasculitis, Leukocytoclastic, Cutaneous/complications , Adult , Diagnosis, Differential , Fatal Outcome , Female , Humans , Intracranial Hemorrhages/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Magnetic Resonance Imaging , Vasculitis, Central Nervous System/diagnosis , Vasculitis, Leukocytoclastic, Cutaneous/diagnosisABSTRACT
Paraneoplastic chorea occurs most commonly in association with small cell lung cancer, often in combination with other paraneoplastic phenomena and sometimes with distinctive basal ganglia T2-weighted MRI hyperintensities. A case of acute-onset chorea is presented in which this phenomenon, combined with transverse myelitis, neuropathy and the described characteristic MRI changes prompted positron emission tomography scanning, in which evidence of probable small cell cancer was uncovered.
Subject(s)
Chorea/etiology , Lung Neoplasms/complications , Myelitis, Transverse/etiology , Peripheral Nervous System Diseases/etiology , Small Cell Lung Carcinoma/complications , Aged , Female , Fluorodeoxyglucose F18 , Humans , Lung Neoplasms/diagnosis , Magnetic Resonance Imaging/methods , Positron-Emission Tomography/methods , Small Cell Lung Carcinoma/diagnosisABSTRACT
Late-life onset aura-like symptoms are not rare and can be potentially misdiagnosed as transient ischaemic attacks. The cause is often obscure. Four cases of recurrent aura-like symptoms are presented in whom acute convexity subarachnoid haemorrhage (SAH) contralateral to symptoms was demonstrated. Three experienced subsequent events or groups of events triggered by recurrent SAH. Negative diffusion-weighted imaging, normal electroencephalography and slow symptom march with complete resolution argued against ischaemic and epileptic causes. Aura-like symptoms in the elderly should be investigated with imaging modalities most sensitive for detecting subarachnoid blood, in particular gradient echo magnetic resonance imaging.
