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Cerebral Amyloid Angiopathy with Inflammation (CAARI)

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This next patient had some memory loss, and what we see here is

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multiple foci of old hemosiderin staining on the GRE sequence. So This looks

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like a cerebral amyloid angiopathy case. But on the T2 weighted image here,

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we see extensive T2 hyperintensity surrounding these zones of GRE susceptibility

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artifact. So this is actually cerebral amyloid angiopathy with inflammation.

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On the FDG PET here, we had some cortical hypometabolism in the bilateral

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parietal lobes, which you see more profoundly here on the right hand side.

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And as we mentioned before, APOE4 is a significant risk factor for cerebral

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amyloid angiopathy. One interesting fact is cerebral amyloid angiopathy

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is found in 5% of the general population, but in 80%

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of patients with Alzheimer's disease. So that's a really big number.

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Again, I believe it comes down to the pathway of a beta amyloid

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deposition from the APOE40 and the APOE42 with disruption of that pathway

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in terms of either production or degradation of those products and then

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accumulation along the vessel walls in the cortex.

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This is another case here of cerebral amyloid angiopathy with inflammation.

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Here's the initial presentation where we have this big bleed in the right

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temporal lobe. We also have multiple other little foci of old hemosiderin

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staining. And then on the FLAIR sequence, we see surrounding FLAIR hyperintensity.

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So this was a CAA with inflammation. One week following steroid therapy,

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the blood products are still there, but that surrounding inflammation has

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gone down. So steroids are very helpful when you have inflammation with

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CAA. This patient happened to be a 71 year old woman with headache

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and cognitive change. Now, this type of appearance is very similar to an

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ARIA appearance. ARIA stands for amyloid related imaging abnormalities,

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which we're going to talk about very shortly.

Report

Faculty

Suzie Bash, MD

Medical Director of Neuroradiology

San Fernando Valley Interventional Radiology & Imaging (SFI), RadNet

Tags

Vascular

PET

Non-infectious Inflammatory

Neuroradiology

Neuro

MRI

CT

Brain

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