title: Stroke-Like Episodes Heralding a Reversible Encephalopathy: Microbleeds as the Key to the Diagnosis of Cerebral Amyloid Angiopathy-Related Inflammation-A Case Report and Literature Review.
abstract: BACKGROUND
  Cerebral amyloid angiopathy (CAA) is a common, often asymptomatic disease. Lobar intracerebral hemorrhage is the most frequent manifestation of CAA. Nevertheless, presentation of CAA with subacute cognitive decline, seizures, or headache with concomitant hyperintensities on T2-weighted magnetic resonance imaging (MRI) sequences and neuropathologic evidence of inflammation has been described. This disorder is known as CAA-related inflammation (CAA-ri).
  
  
  METHODS
  Description of a stroke-like presentation of CAA-ri and systematic review of case reports and case series of CAA-ri.
  
  
  RESULTS
  A 75-year-old woman with a history of atrial fibrillation, and a transient episode of aphasia 2 days before, presented in the emergency room with sudden onset aphasia. Brain computed tomography disclosed a left temporal hypodensity. A diagnosis of probable stroke was given. During the following days, there was a progressive clinical deterioration. MRI revealed coalescent edematous white matter lesion, hyperintense on T2-weighted sequences, and multiple lobar microbleeds on T2*-weighted sequences. A diagnosis of CAA-ri was considered, and the patient was started on steroids with clinical and imaging improvement. From our systematic review, microbleeds were present in almost 90% of patients with CAA-ri.
  
  
  CONCLUSIONS
  Imaging findings associated with CAA-ri allow the early diagnosis and treatment of this potentially reversible disorder. Aside from the most common subacute presentations, CAA-ri can have a stroke-like presentation and be a stroke mimic.
authors.affiliation: Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Centro de Estudos de Doenças Crónicas (CEDOC), Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. Electronic address: marcelomendoncasousa@gmail.com.
authors.forename: Marcelo D
authors.initials: MD
authors.lastname: Mendonça
authors.affiliation: Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: André
authors.initials: A
authors.lastname: Caetano
authors.affiliation: Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pinto
authors.affiliation: Neuroimaging Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Vera
authors.initials: V
authors.lastname: Cruz e Silva
authors.affiliation: Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Centro de Estudos de Doenças Crónicas (CEDOC), Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Viana-Baptista
mesh_terms: D000368:Aged; D016657:Cerebral Amyloid Angiopathy / Q000150:complications* / Q000175:diagnosis*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005260:Female; D006801:Humans; D007249:Inflammation; D008279:Magnetic Resonance Imaging; D020521:Stroke / Q000503:physiopathology*
keywords: Stroke; cerebral amyloid angiopathy; cerebral amyloid angiopathy-related inflammation; microbleeds