A case of cerebral amyloid angiopathy-related inflammation where MR spectroscopy was helpful for differential diagnosis
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Cerebral amyloid angiopathy-related inflammation, a rare and treatable variant of cerebral amyloid angiopathy, lacks specific imaging findings and requires invasive brain biopsy to confirm the diagnosis. Recent studies have pointed out that magnetic resonance (MR) spectroscopy findings can help the diagnosis noninvasively. We report the case of amyloid angiopathy-related inflammation that required differential diagnosis from cerebral venous infarction and low-grade glioma. MR spectroscopy findings indicated amyloid angiopathy-related inflammation and the biopsy results confirmed the diagnosis. A 62-year-old male presented to our department with left homonymous hemianopia. Computed tomography (CT) showed a low-attenuating subcortex lesion on the right occipital lobe. The lesion showed low intensity in T1-weighted MR images, high intensity in T2-weighted MR images, and no enhancement in T1-weighted MR contrast-enhanced images. Angiography did not show any abnormal findings. MR spectroscopy showed a normal N-acetylasparate (NAA)/Cr ratio (>1) and no increase in the choline (Cho)/Cr ratio on the lesion. These finding indicated amyloid angiopathy-related inflammation. We biopsied the right occipital subcortex and confirmed the diagnosis of cerebral amyloid angiopathy-related inflammation. Presently, the patient is well controlled with oral prednisolone (dose, 5 mg/day). The MR spectroscopy findings encouraged invasive brain biopsy and we confirmed the diagnosis of amyloid angiopathy-related inflammation.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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