Multiple intracranial hemorrhages in a normotensive demented patient: A probable cerebral amyloid angiopathy
A normotensive 68-year-old male who suffered from dementia without parkinsonism sign and symptoms, presented with hemiparesia without any decrease in level of consciousness. Symptoms started since two weeks before admission with headache, nausea, vomiting and hemiparesia. The severity of headache and permanent weakness forced the patient and his relatives seeking medical care. Past medical history revealed a progressive dementia since one year ago without history of hypertension or other related medical conditions. He did not have any history of trauma, but he had two attacks of transient hemiparesia and headache in previous year neglected as senile symptoms. Other than hemiparesia, neurological examination at the first day and at the time of discharge revealed that cognition impairment was compatible with subcortical dementia. Laboratory examinations, including: complete blood counts, electrolytes, liver and renal function tests, and coagulation tests were all within normal ranges. Computed tomography (CT) showed three well defined hyperdense cortical lesions over the both parietal lobes and left insular lobe without mass effect or surrounding edema (). The further investigation using magnetic resonance imaging (MRI) with administration of contrast agent revealed neither further enhancements nor additional information compared to CT scan ().\nAfter 2 weeks, while the patient was hospitalized, we took another CT scan, and there was no evidence of previous lesions as shown in . Therefore, according to a documented multiple superficial intracerebral hemorrhage and other criteria, diagnose of probable CAA was introduced. Throughout the hospitalization, standard management of ICH was done and finaly, the patient was discharged with the order of cognitive enhancer drugs and rehabilitation.