Amyloid β-related angiitis presented only a leptomeningeal legion and enlarged perivascular spaces without detection of hemorrhagic lesions at first visit: a case report

Abstract

A 70-year-old woman visited our hospital with a chief complaint of headache. T2-weighted and fluid-attenuated inversion-recovery magnetic resonance imaging (MRI) showed a leptomeningeal lesion in the right temporal lobe and many enlarged perivascular spaces in the centrum semiovale. Follow-up MRI performed 6 months later revealed cortical microbleeds and cortical superficial siderosis. Three years later, the patient presented with right lower quadrant homonymous hemianopsia and disturbance of consciousness. MRI showed diffuse leptomeningeal and significantly increased hemorrhagic lesions. A brain biopsy confirmed diagnosis of amyloid β-related angiitis. Disturbance of consciousness persisted despite steroid treatment. We concluded that vasculitis-induced inflammation preceded bleeding secondary to vascular fragility in our patient. Inflammatory cerebral amyloid angiopathy should be included in the differential diagnosis in patients with early-onset leptomeningeal lesions and enlarged perivascular spaces without hemorrhagic lesions.