Nota Clínica

Response to treatment with corticoids in a case of inflammatory amyloid angiopathy without performing a biopsy

P. de la Riva, F. Moreno, N. Carrera, M. Barandiarán, M. Arruti, J.F. Martí-Massó [REV NEUROL 2012;55:408-412] PMID: 23011859 DOI: https://doi.org/10.33588/rn.5507.2012155

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Volumen 55 | Number 07 | Nº of views of the article 7.354 | Nº of PDF downloads 540 | Article publication date 01/10/2012

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ABSTRACT

INTRODUCTION Inflammatory amyloid angiopathy (IAA) is an infrequent presenting symptom of the recently recognised cerebral amyloid angiopathy and its definitive diagnosis is reached by means of pathological analyses.

AIM We report the case of a male patient with IAA and good clinical, neuropsychological and neuroimaging response to treatment with corticoids; a biopsy of brain tissue was not considered necessary.

CASE REPORT The patient, 68 years old and diagnosed with Alzheimer’s disease, suffered from generalised seizures followed by a language disorder and hemiparesis of the right-hand side. A magnetic resonance imaging scan showed a lesion displaying infiltrating behaviour in the left hemisphere and multiple instances of microbleeding. Clinical and radiological features suggested IAA and treatment was established with corticoids. Neuroimaging and neuropsychological tests revealed a notable improvement at 30 days after beginning treatment with immunosuppressants. The genotype was ApoE e4/e4. The need to perform a biopsy of brain tissue was ruled out.

CONCLUSIONS The case described here suggests that, in individualised cases with clinical and radiological features that are characteristic of IAA, it may be possible to establish an empirical treatment with corticoids with a probability diagnosis and perform a biopsy of brain tissue in the event of a lack of response to treatment. KeywordsAmyloid Angiopathy Biopsy Corticoids Encephalopathy Inflammatory Microbleeding

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Nota Clínica

Response to treatment with corticoids in a case of inflammatory amyloid angiopathy without performing a biopsy

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