Disclosures: Marc C. Ramos Emos, MD: No financial relationships or conflicts of interest

Case Diagnosis: 83-year-old female with Cerebral Amyloid Angiopathy (CAA)

Case Description or Program Description: Patient presented to the hospital with nausea, vomiting, and right-sided upper extremity weakness. CT Head showed left frontal lobe intraparenchymal hemorrhage and small volume subarachnoid hemorrhage. Findings were also seen on MRI. CT angiogram of head and neck was negative. Echocardiogram was negative for intracardiac shunt and thrombus. Patient was managed in ICU and blood pressure was optimized. During hospitalization, patient experienced transient episodes of word finding difficulties and dysarthria lasting several minutes. Continuous EEG was ordered for further workup

Setting: Tertiary Care Academic Hospital

Assessment/Results: While monitoring on EEG, patient experienced two episodes of speech deficits. There was no epileptiform activity during the episodes. Keppra was started which decreased the frequency of these episodes. Repeat MRI brain showed new bilateral frontal lobes infarctions. Based on symptoms and imaging findings, patient was diagnosed with cerebral amyloid angiopathy as etiology of hemorrhages. Transient speech deficits were deemed as transient focal neurologic episodes (TFNE) as opposed to seizures.

Discussion (relevance): CAA is a type of cerebrovascular disorder characterized by the accumulation of amyloid beta-peptide within the cerebral blood vessels. The most common clinical effect of CAA is an intracranial hemorrhage. The clinical presentation of CAA includes delirium, altered vision, sensation changes, speech problems, muscle weakness and TFNE. TFNE, also called amyloid spells, are common in CAA and include both positive and negative neurological symptoms. They may be caused by superficial cortical siderosis or convexity subarachnoid hemorrhage. The diagnosis of CAA is hard to confirm without a sample of brain tissue. There is no cure for CAA, but rehabilitative treatment is utilized to relieve symptoms.

Conclusions: We present a case of CAA leading to diffuse intracranial hemorrhage and transient focal neurologic episodes. Differentiating TFNE from seizures is crucial as the presence of TFNE predicts the risk of symptomatic intracranial hemorrhage.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/transient-focal-neurologic-episodes-in-a-patient-with-diffuse-intracranial-hemorrhage-a-case-report/