Cerebral amyloid angiopathy mimicking central nervous system metastases: a case report

• Published in: Journal of medical case reports Vol. 12; no. 1; p. 133
• Main Authors: DeZorzi, Christopher, Fernandez-Ruiz, Ruth, Gupta, Sarika, Harris, Katherine
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.05.2018; BioMed Central; BMC
• Subjects: Aged; Alzheimer’s disease; Anticoagulants; Brain - diagnostic imaging; Brain - pathology; Cancer metastasis; Care and treatment; Case Report; Case studies; Cerebral amyloid angiopathy; Cerebral Amyloid Angiopathy - diagnostic imaging; Cerebral Amyloid Angiopathy - economics; Cerebral Amyloid Angiopathy - pathology; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - pathology; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - economics; Cerebral Hemorrhage - etiology; Cerebral Hemorrhage - pathology; Clinical pathology; Costs and Cost Analysis; Dementia; Diagnosis; Diagnosis, Differential; Female; Humans; Intracranial hemorrhage; Magnetic Resonance Imaging - economics; Magnetic Resonance Imaging - utilization; Nervous system cancer; Practice Guidelines as Topic; Tomography, X-Ray Computed - economics; Tomography, X-Ray Computed - utilization; Treatment Outcome; Intracranial hemorrhage; Cerebral amyloid angiopathy; Alzheimer’s disease; Clinical pathology; Dementia
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-018-1655-6

This case describes an unusual presentation of an intracranial hemorrhage first thought to be metastatic disease on computed tomography and magnetic resonance imaging. The healthcare team completed an exhaustive search for a primary malignancy that was negative. Final diagnosis on brain biopsy showed intercranial hemorrhage secondary to cerebral amyloid angiopathy. With an increasing number of elderly patients and the rising cost of health care, this case can serve as a reminder to clinicians about their own responsibilities in limiting the cost of health care. This is a case report about a 72-year-old white woman with an intracranial hemorrhage secondary to cerebral amyloid angiopathy. The brain lesions on computed tomography/magnetic resonance imaging mimicked a metastatic process until a brain biopsy could give a definitive diagnosis that was completely unexpected. Cerebral amyloid angiopathy is a rare cause of intracerebral hemorrhage and this diagnosis is important to consider in older patients on anticoagulation. Cerebral amyloid angiopathy is a rare diagnosis but should be considered in elderly patients on anticoagulation presenting with imaging findings consistent with intracerebral hemorrhage. While metastatic disease is a more common cause of intracerebral hemorrhage, cerebral amyloid angiopathy should remain in the differential diagnosis. This case report serves as a teaching point to clinicians in cases involving an older patient on anticoagulation.