Question 2695
{"accessible":true,"alternatives":[{"id":13187,"text":"hypertensive arteriopathy with posterior reversible encephalopathy syndrome"},{"id":13188,"text":"cerebral amyloid angiopathy related inflammation"},{"id":13189,"text":"cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy"},{"id":13190,"text":"cerebral fat embolism"},{"id":13191,"text":"diffuse axonal injury"}],"archived":false,"correctAlternativeId":13188,"explanation":"\u003cp\u003eThe SWI shows numerous cerebral microbleeds at corticosubcortical locations in the temporal and frontal lobes. There is also confluent, expansile T2 hyperintensity of the immediately subcortical white matter, which is asymmetric at the level of the frontal lobes. Presuming no deep cerebral hemorrhages, these findings meet the diagnostic criteria for probable cerebral amyloid related inflammation (CAA-ri).\u003c/p\u003e\u003cp\u003eHypertensive arteriopathy and posterior reversible encephalopathy syndrome (PRES) could also cause lobar cerebral microbleeds and subcortical vasogenic edema. However, the microbleeds are usually not this numerous and the edema is usually symmetric, with a posterior predominance or watershed distribution.\u003c/p\u003e\u003cp\u003eCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) could also cause anterior temporal lobe subcortical white matter hyperintensities and cerebral microbleeds. However, the profusion of corticosubcortical microbleeds in this case is not a typical in distribution or number for CADASIL. Moreover, the white matter hyperintensities are usually symmetric in CADASIL.\u003c/p\u003e\u003cp\u003eCerebral fat embolism could also cause profuse cerebral microbleeds. However, these microbleeds are typically distributed diffusely throughout the white matter rather than concentrated at corticosubcortical sites with lobar asymmetry. The microbleeds in acute cerebral fat embolism also tend to appear quite small compared to the chronic microbleeds of cerebral amyloid angiopathy. Cerebral fat embolism can cause small areas of cytotoxic edema but these large areas of white matter hyperintensity seen in this case would not be typical.\u003c/p\u003e\u003cp\u003eDiffuse axonal injury could cause cerebral microbleeds, but the distribution tends to be more of radially oriented within subcortical white matter and corpus callosum rather than scattered in the lobar corticosubcortical regions. Brain contusions that go with diffuse axonal injury could manifest as white matter hyperintensities but they are typically not as large as the areas seen in this case. This case did not have a history of trauma that would support this possibility.\u003c/p\u003e","id":2695,"imageUrl":"https://prod-images-static.radiopaedia.org/multiple_choice_questions/1052/CAAri_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":58270},"imageAttributionCaseInfo":{"title":"Cerebral amyloid angiopathy-related inflammation","contributor_name":"Y. Amy Chen","contributor_param":"y-amy-chen","case_rid":58270,"case_param":"cerebral-amyloid-angiopathy-related-inflammation-1"},"firstQuestionPath":"/questions/2695","nextQuestionPath":null,"relatedArticles":[{"id":1915,"title":"Posterior reversible encephalopathy syndrome","link":"/articles/posterior-reversible-encephalopathy-syndrome-1?lang=us"},{"id":13562,"title":"Diffuse axonal injury","link":"/articles/diffuse-axonal-injury?lang=us"},{"id":29525,"title":"Cerebral fat embolism","link":"/articles/cerebral-fat-embolism?lang=us"},{"id":28684,"title":"Hypertensive microangiopathy","link":"/articles/hypertensive-microangiopathy?lang=us"},{"id":1027,"title":"Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)","link":"/articles/cerebral-autosomal-dominant-arteriopathy-with-subcortical-infarcts-and-leukoencephalopathy-cadasil-1?lang=us"}],"alsoUsedIn":[{"id":1903,"kind":"Course","title":"Radiopaedia 2024 - Virtual Conference - page 1903","link":"https://radiopaedia.org/courses/radiopaedia-2024-virtual-conference/pages/1903"},{"id":1903,"kind":"Course","title":"2024 Virtual Conference Private Use - page 1903","link":"https://radiopaedia.org/courses/2024-virtual-conference-private-use/pages/1903"},{"id":1468,"kind":"Course","title":"2023 Virtual Conference Private Use - page 1468","link":"https://radiopaedia.org/courses/2023-virtual-conference-private-use/pages/1468"},{"id":1468,"kind":"Course","title":"Neuroradiology Lectures - page 1468","link":"https://radiopaedia.org/courses/neuroradiology-lectures/pages/1468"},{"id":1468,"kind":"Course","title":"New test course - page 1468","link":"https://radiopaedia.org/courses/new-test-course/pages/1468"}],"stem":"\u003cp\u003eA 65-year-old patient presented with several months history of headaches and progressive cognitive decline. Based on only these MR images, 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/2695"}],"attemptsPercentages":[{"alternativeId":"13189","percentage":30},{"alternativeId":"13188","percentage":61},{"alternativeId":"13190","percentage":1},{"alternativeId":"13187","percentage":7},{"alternativeId":"13191","percentage":2}],"promptToLogin":false,"questionManager":false,"articleId":"inflammatory-cerebral-amyloid-angiopathy"}