{"id":"238d47cb-11f4-4f6c-8c9f-d8a252c91048","slug":"acute-progression-of-cerebral-amyloid-angiopathy-related-inflammation-diagnosed-by-biopsy-in-an-elderly-patient-a-case-report","title":"Acute progression of cerebral amyloid angiopathy-related inflammation diagnosed by biopsy in an elderly patient: A case report","authors":["Kiyonori Kuwahara","Shigeta Moriya","Ichiro Nakahara","Tadashi Kumai","Shingo Maeda","Yuya Nishiyama","Midoriko Watanabe","Yoshikazu Mizoguchi","Yuichi Hirose"],"abstract":"Background: Cerebral amyloid angiopathy-related inflammation (CAA-I) presents with slowly progressive nonspecific neurological symptoms, such as headache, cognitive function disorder, and seizures. Pathologically, the deposition of amyloid-β proteins at the cortical vascular wall is a characteristic and definitive finding. Differential diagnoses include infectious encephalitis, neurosarcoidosis, primary central nervous system lymphoma, and glioma. Here, we report a case of CAA-I showing acute progression, suggesting a glioma without enhancement, in which a radiological diagnosis was difficult using standard magnetic resonance imaging. Case Description: An 80-year-old woman was admitted due to transient abnormal behavior. Her initial imaging findings were similar to those of a glioma. She presented with rapid progression of the left hemiplegia and disturbance of consciousness for 6 days after admission and underwent emergent biopsy with a targeted small craniotomy under general anesthesia despite her old age. Intraoperative macroscopic findings followed by a pathological study revealed CAA-I as the definitive diagnosis. Steroid pulse therapy with methylprednisolone followed by oral prednisolone markedly improved both the clinical symptoms and imaging findings. Conclusion: Differential diagnosis between CAA-I and nonenhancing gliomas may be difficult using standard imaging studies in cases presenting with acute progression. A pathological diagnosis under minimally invasive small craniotomy may be an option, even for elderly patients.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/238d47cb-11f4-4f6c-8c9f-d8a252c91048/featured/hero-1781561235231.png","publishDate":"2022-06-23T00:00:00.000Z","doi":"10.25259/SNI_195_2022","categories":["Neurovascular","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/06/11675/SNI-13-268.pdf"}