Anup Banerjee
Stockport NHS Foundation Trust, UKPresentation Title:
A case of inflammatory cerebral amyloid angiopathy: The importance of early recognition and treatment
Abstract
Cerebral Amyloid Angiopathy (CAA) is increasingly recognized as a major contributor to cognitive decline and intracerebral hemorrhage in the elderly. A less commonly recognized but clinically significant variant, inflammatory CAA (iCAA), presents a diagnostic challenge due to its varied and often non-specific manifestations. This case highlights the importance of early recognition and treatment of iCAA, a rare yet potentially reversible cause of neurological dysfunction.
We present the case of a 76-year-old male with no prior history of dementia who was admitted with expressive dysphasia, transient confusion, and new-onset generalized seizures. Neuroimaging revealed widespread cortical microbleeds and superficial siderosis, raising suspicion for CAA. Further MRI sequences demonstrated asymmetric white matter hyperintensities, consistent with vasogenic edema. Routine blood tests and cerebrospinal fluid analysis were unremarkable. A working diagnosis of probable inflammatory CAA was made based on clinicoradiological criteria.
The patient responded dramatically to high-dose intravenous corticosteroids followed by an oral taper, with complete resolution of symptoms and improvement in cognitive function. Follow-up imaging at six weeks showed a reduction in the extent of edema. He remained clinically stable on outpatient review at three months.
This case emphasizes the need for heightened clinical awareness of iCAA, particularly in elderly patients presenting with acute or subacute cognitive decline, seizures, or focal neurological deficits. Unlike non-inflammatory CAA, the inflammatory subtype is steroid-responsive and potentially reversible, underscoring the value of timely diagnosis and intervention. MRI plays a pivotal role in identifying characteristic radiological features, especially in settings where brain biopsy is impractical.
We advocate for greater consideration of iCAA in relevant clinical contexts and suggest that early immunosuppressive therapy may significantly alter prognosis. This case supports expanding differential diagnoses in older patients with new neurological symptoms and unexplained imaging findings.
Biography
Anup Banerjee passed his primary medical school from Bangladesh in 2017. He worked in Bangladesh as a medical officer in medicine department for four years. He got his GMC registration and license to practice medicine in UK in 2022. Since 2023 he is working as a clinical fellow in Stockport NHS Foundation Trust, UK. He has published numerous case reports in different medical journals indexed by PubMed.
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