title: Amyloid spells and high blood pressure: imminent danger?
abstract: We present the case of a 71-year-old male, admitted after a generalized tonic-clonic seizure, with a history of recurrent left arm and face paresthesias, associated with sulcal cortical subarachnoid hemorrhages. During the next 48 h, he remained agitated with a high blood pressure profile; he also suffered a cardiac arrest in relation to a severe left fronto-parietal and a smaller right parietal parenchymal hemorrhage that developed over the subarachnoid hemorrhage locations. There were no intracranial vascular abnormalities. Three months later, an MRI revealed disseminated superficial siderosis. He was discharged with a modified Rankin scale of 4. He died 1 month later of unknown cause. A diagnosis of probable cerebral amyloid angiopathy was assumed. Patients with pathologically proven cerebral amyloid angiopathy that present with transient focal neurological symptoms in relation to cortical bleeds, the so-called 'myloid spells' seem to be at an increased risk of future parenchymal hemorrhages. Avoiding antiplatelet agents in these cases has been proposed. Our case suggests that these patients should be monitored closely in the hyperacute phase, and tight blood pressure control should be considered as the immediate risk of bleeding may be high, even without a definitive diagnosis of cerebral amyloid angiopathy.
authors.affiliation: Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Andre
authors.initials: A
authors.lastname: Caetano
authors.affiliation: Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pinto
authors.affiliation: Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal ; CEDOC - Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Calado
authors.affiliation: Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal ; CEDOC - Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Viana-Baptista
keywords: Cerebral amyloid angiopathy; Cortical and leptomeningeal vessels; Elderly patients