2018 Volume 51 Issue 3 Pages 229-233
The patient was a 68-year-old male. He had been diagnosed with IgA nephropathy based on a kidney biopsy 6 years ago. However, he missed his clinic appointment. He was emergently admitted to our hospital due to a headache and alexia. At the time of his hospitalization, his neurological signs had disappeared. On the other hand, a clinical examination demonstrated evidence of end-stage kidney disease and hypertension (serum creatinine: 8.60 mg/dL, serum potassium: 6.7 mEq/L, blood pressure: 245/112 mmHg). Brain magnetic resonance imaging (MRI) showed multiple microbleeds in the bilateral medulla oblongata, cerebellum, and cerebral hemisphere and angioedema in the right parietal occipital lobe. The patient was diagnosed with cerebral amyloid angiopathy (CAA) and posterior reversible encephalopathy syndrome (PRES) based on brain MRI. Hemodialysis was initiated immediately on admission, and antihypertensive therapy was started promptly. The patient’s blood pressure gradually came under control. On day 14 of the illness, brain MRI showed that the posterior leukoencephalopathy had improved. CAA usually occurs in elderly individuals, and it is characterized by the deposition of β-amyloid in the walls of cerebral blood vessels. CAA sometimes causes inflammatory CAA. In this case, the leukoencephalopathy was probably caused by PRES because of its rapid improvement.
