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Cerebral Amyloid Angiopathy Presenting as Nonhemorrhagic Diffuse Encephalopathy: Neuropathologic and Neuroradiologic Manifestations in One CaseGo

Massimo Cauloa, Donatella Tampieria, Roland Brassarda, Marie Christine Guiota and Denis Melansona

a From the Departments of Neuroradiology (M.C., D.T., R.B., D.M.) and Neuropathology (M.C.G.), Montreal Neurological Institute of McGill University, Montreal, Canada, and the Department of Radiology (M.C.), University of L'Aquila, L'Aquila, Italy.



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  		FIG 1. Images obtained at the time of the first hospital admission. Axial view turbo spin-echo T2-weighted sequence.

A, and B, Diffuse high intensity signal involving the cortex and the white matter of the right temporo-parieto-occipital region. Note also the involvement of the right frontal and left parieto-occipital regions.

C, High intense signal can be seen in the occipital lobes bilaterally, involving both the gray and white matter.



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  		FIG 2. Histopathologic examinations of the lesions.

A, Hematoxylin and eosin stain. Vessel walls are thickened by an amorphous eosinophilic substance, and the lumen of the vessel is partially occluded.

B, Immunohistochemistry for glial fibrillary acidic protein shows perivascular gliosis.

C, Immunohistochemistry for ß-amyloid shows the presence of amyloid deposits in the vessel walls.



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  		FIG 3. Images obtained at the 1-year follow-up examination.

A, and B, Axial view spin-echo T2-weighted sequence. High intense signal is present in the gray and white matter of the right frontal lobe and of both parietal lobes. Note that compared with figure 1, there is progression of the disease in the left parietal lobe. The right parietal lobe, on the contrary, looks less involved.

C, Axial view spin-echo T2-weighted sequence. The lesion on the left is involving also the temporal lobe.

D, Axial view fluid-attenuated inversion recovery sequence obtained at the same level as that shown in A. The parietal lobes are diffusely hyperintense. High intensity signal is also present in the right frontal lobe. The right parietal lobe appears less involved than on the previous MR image.

E, Axial view fluid-attenuated inversion recovery sequence obtained at the same level as that shown in B. The parietal lobes are diffusely hyperintense. High intensity signal is also present in the right frontal lobe. The right parietal lobe appears less involved than on the previous MR image.

F, Axial view fluid-attenuated inversion recovery sequence obtained at the same level as that shown in C. The parietal lobes are diffusely hyperintense. High intensity signal is also present in the right frontal lobe. The right parietal lobe appears less involved than on the previous MR image.

G, Infused axial view spin-echo T1-weighted sequence. There is no evidence of abnormal contrast enhancement in the diseased regions.

H, Infused axial view spin-echo T1-weighted sequences. There is no evidence of abnormal contrast enhancement in the diseased regions.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X