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A 75-year-old man with a history of recent memory impairment is
admitted with headache, confusion, and a left homonymous hemianopsia.
He has recently had two episodes of brief unresponsiveness. There is no history
of hypertension. Computed tomography (CT) scan shows a right occipital
lobe hemorrhage with some subarachnoid extension of the blood. An
MRI scan with gradient echo sequences reveals foci of hemosiderin in the
right temporal and left frontal cortex. The likely cause of this patient’s symptoms
and signs is
a. Gliomatosis cerebri
b. Multi-infarct dementia
c. Mycotic aneurysm
d. Amyloid angiopathy
e. Undiagnosed hypertension
admitted with headache, confusion, and a left homonymous hemianopsia.
He has recently had two episodes of brief unresponsiveness. There is no history
of hypertension. Computed tomography (CT) scan shows a right occipital
lobe hemorrhage with some subarachnoid extension of the blood. An
MRI scan with gradient echo sequences reveals foci of hemosiderin in the
right temporal and left frontal cortex. The likely cause of this patient’s symptoms
and signs is
a. Gliomatosis cerebri
b. Multi-infarct dementia
c. Mycotic aneurysm
d. Amyloid angiopathy
e. Undiagnosed hypertension
Fri, 2009-02-27 08:20
qusei
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b. Multi-infarct dementia
(CAA), or congophilic angiopathy, is the most common cause of lobar hemorrhage
in elderly patients without hypertension. The deposition of
amyloid protein (the same as that found in Alzheimer’s disease) in brain
blood vessels leads to disruption of the vessel walls, which predisposes
them to hemorrhage. Patients are usually over age 70 and may present with
multiple cortical hemorrhages with or without a history of dementia. At
times, additional hemorrhages may be seen only on special imaging techniques,
such as gradient echo MRI, which magnifies the effects of hemosiderin
in regions of prior hemorrhage.