Cerebral amyloid angiopathy-related transient focal neurological episodes with diffusion-weighted imaging hyperintense lesions in subcortical white matter and cortical superficial siderosis

Abstract

A 72-year-old man presented with two episodes of migratory left-sided paresthesia lasting 10 min. At the first episode, diffusion-weighted imaging hyperintense lesions (DWIHLs) were seen in the right parietal lobe, suggesting an initial diagnosis of acute ischemic stroke, for which we administered antiplatelet therapy for secondary prevention. Four months later, he again developed transient migratory left-sided paresthesia. Gradient-echo T₂*-weighted imaging at this time showed disseminated cortical superficial siderosis (cSS) and strictly cerebral microbleeds around the DWIHLs in the right parietal lobe. These findings led to a diagnosis of cerebral amyloid angiopathy and its related findings, including transient focal neurological episodes (TFNE) and DWIHLs, and antiplatelet medication was stopped. In clinical settings, although it is challenging to distinguish TFNE of hemorrhagic origin from cerebral ischemic symptoms, including transient ischemic attacks, this case suggests that even when elderly patients with transient neurological symptoms present with cortical DWIHLs, paramagnetic-sensitive MRI should be performed to check for cSS around the DWIHLs.