Question 1023
{"accessible":true,"alternatives":[{"id":5129,"text":"cerebral amyloid angiopathy"},{"id":5130,"text":"diffuse axonal injury"},{"id":5131,"text":"familial cavernous malformation syndrome"},{"id":5132,"text":"neurocysticercosis"},{"id":5133,"text":"poorly controlled hypertension"}],"archived":false,"correctAlternativeId":5129,"explanation":"\u003cp\u003eThis single axial SWI image demonstrates multiple low-signal lobar \u003ca href=\"/articles/cerebral-microhaemorrhage\"\u003ecerebral microhemorrhages\u003c/a\u003e\u0026nbsp;bilaterally, particularly with a posterior predominance, and numerous sulci affected by low-signal \u003ca href=\"/articles/cortical-superficial-siderosis\" title=\"Cortical superficial siderosis\"\u003ecortical superficial siderosis\u003c/a\u003e\u0026nbsp;bilaterally. Given the patient is elderly, these changes are characteristic of \u003ca href=\"/articles/cerebral-amyloid-angiopathy-1\"\u003ecerebral amyloid angiopathy\u003c/a\u003e\u0026nbsp;(CAA). The headache in this patient may be related to a new \u003ca href=\"/articles/convexal-subarachnoid-haemorrhage\"\u003econvexity subarachnoid hemorrhage\u003c/a\u003e, or may be unrelated and incidental.\u003c/p\u003e\u003cp\u003eCAA has numerous radiological manifestations, including \u003ca href=\"/articles/lobar-haemorrhage\"\u003elobar intracerebral hemorrhage\u003c/a\u003e ('macrohaemorrhage'), lobar cerebral microhemorrhages,\u0026nbsp;convexity subarachnoid hemorrhage and cortical superficial siderosis, the presence of which has been incorporated into\u0026nbsp;the \u003ca href=\"/articles/modified-boston-criteria-for-cerebral-amyloid-angiopathy-1\"\u003eModified Boston Criteria\u003c/a\u003e\u0026nbsp;to diagnose CAA without need for invasive biopsy. Additional radiological manifestations include ischemic leukoencephalopathy, microinfarcts, lobar lacunes,\u0026nbsp;dilated perivascular spaces of the centrum semiovale, and cerebral atrophy.\u003c/p\u003e\u003cp\u003eThe primary differential diagnosis in an elderly patient for CAA would be poorly controlled hypertension, however, that is associated with cerebral microhemorrhages within 'deep' structures (e.g. basal ganglia, pons) and is not associated with cortical superficial siderosis.\u003c/p\u003e","id":1023,"imageUrl":"https://prod-images-static.radiopaedia.org/images/1486324/71ed9496e03498c31af2144191cd8d_big_gallery.jpg","imageAttribution":{"kind":"case","rID":15826},"imageAttributionCaseInfo":{"title":"Cerebral amyloid angiopathy","contributor_name":"Royal Melbourne Hospital","contributor_param":"rmh","case_rid":15826,"case_param":"cerebral-amyloid-angiopathy-2"},"firstQuestionPath":"/questions/2696","nextQuestionPath":"/articles/cerebral-microhaemorrhage/questions/739","relatedArticles":[{"id":1724,"title":"Neurocysticercosis","link":"/articles/neurocysticercosis?lang=us"},{"id":6562,"title":"Familial multiple cavernous malformation syndrome","link":"/articles/familial-multiple-cavernous-malformation-syndrome?lang=us"},{"id":28684,"title":"Hypertensive microangiopathy","link":"/articles/hypertensive-microangiopathy?lang=us"},{"id":13562,"title":"Diffuse axonal injury","link":"/articles/diffuse-axonal-injury?lang=us"},{"id":6691,"title":"Cerebral amyloid angiopathy","link":"/articles/cerebral-amyloid-angiopathy-1?lang=us"},{"id":48897,"title":"Modified Boston criteria for cerebral amyloid angiopathy (historical)","link":"/articles/modified-boston-criteria-for-cerebral-amyloid-angiopathy-historical?lang=us"},{"id":184756,"title":"Cortical superficial siderosis","link":"/articles/cortical-superficial-siderosis?lang=us"}],"alsoUsedIn":[{"id":510,"kind":"Course","title":"Neurodegenerative Learning Pathway - page 510","link":"https://radiopaedia.org/courses/neurodegenerative-learning-pathway/pages/510"},{"id":758,"kind":"Course","title":"Stroke Learning Pathway - page 758","link":"https://radiopaedia.org/courses/stroke-learning-pathway/pages/758"},{"id":758,"kind":"Course","title":"[TRIAL] Stroke Learning Pathway - page 758","link":"https://radiopaedia.org/courses/trial-stroke-learning-pathway/pages/758"},{"id":1070,"kind":"Course","title":"Neurodegenerative Learning Pathway - page 1070","link":"https://radiopaedia.org/courses/neurodegenerative-learning-pathway/pages/1070"},{"id":2095,"kind":"Course","title":"Stroke Learning Pathway - peer review - page 2095","link":"https://radiopaedia.org/courses/stroke-learning-pathway-peer-review/pages/2095"}],"stem":"\u003cp\u003eAn elderly man presented with a mild headache and is assessed with brain MRI, an axial SWI image is\u0026nbsp;shown. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1023"}],"attemptsPercentages":[{"alternativeId":"5129","percentage":88},{"alternativeId":"5130","percentage":2},{"alternativeId":"5132","percentage":2},{"alternativeId":"5133","percentage":4},{"alternativeId":"5131","percentage":4}],"promptToLogin":false,"questionManager":false,"articleId":"cerebral-microhemorrhage"}