title: Recurrent stereotyped episodes in cerebral amyloid angiopathy: response to migraine prophylaxis in two patients.
abstract: BACKGROUND
  Cerebral amyloid angiopathy (CAA) typically presents with cognitive decline or symptomatic intracerebral hemorrhage, but episodes of recurrent stereotyped limb attacks have also been reported.
  
  
  METHODS
  Retrospective review of the medical records of 4 patients referred to the general neurology services and a specialist stroke center with clinically probable CAA.
  
  
  RESULTS
  Four subjects, all Caucasian, mean age 74 years, were followed up over a mean duration of 20 months. They all experienced recurrent prolonged stereotyped attacks of sensory symptoms, lasting 5-30 min, that resolved completely between attacks. Three subjects developed intracerebral hemorrhage, and 2 had an irreversible rapid cognitive decline. Two patients experienced symptomatic improvement with migraine prophylaxis (verapamil or topiramate).
  
  
  CONCLUSIONS
  Recurrent stereotyped prolonged attacks with sensory and motor elements can predate the development of intracerebral hemorrhage in individuals with clinically probable CAA. When evaluating patients with such attacks, neurologists need to consider CAA as a possible mimic of transient ischemic attacks. We suggest a trial of migraine prophylaxis for symptomatic management.
authors.affiliation: National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: R W
authors.initials: RW
authors.lastname: Paterson
authors.forename: K
authors.initials: K
authors.lastname: Uchino
authors.forename: H C
authors.initials: HC
authors.lastname: Emsley
authors.forename: P
authors.initials: P
authors.lastname: Pullicino
keywords: Cerebral amyloid angiopathy; Migraine prophylaxis; Recurrent stereotyped episodes