case_images: PMC11721527_01
case_images: Brain MRI (A) T2 FLAIR (fluid attenuated inversion recovery), (B) non-contrast T1 FSE (fast spin echo), (C) post-contrast T1 FSE, and (D) T2* GRE (gradient echo) sequences show multifocal intraparenchymal hemorrhages of varying ages, acute in left anterolateral temporal lobe (long arrow, isointense on T1), subacute in left posterior temporal-occipital lobe (short arrows, hyperintense on T1 with enhancement), and chronic in right posterior temporal-occipital lobe (arrow heads, hypointense on T1) with varying degree of surrounding vasogenic edema and gliosis on T2 FLAIR. Separate slice on T2* GRE (E) shows multiple microhemorrhages in right parieto-occipital juxtacortical distribution (arrow heads) as well as cortical superficial siderosis along the left anterolateral temporal and left parieto-occipital convexities (arrows). Findings meet probable CAA by Boston criteria 2.0: patient's age >50 years, at least two lobar hemorrhagic lesions (intraparenchymal hemorrhages, microhemorrhages, and cortical superficial siderosis), absence of deep hemorrhagic lesions, and presence of white matter hyperintense lesions in multispot pattern on T2 FLAIR (F).
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case_images: PMC11721527_01_gr1.jpg
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case_images: Magnetic resonance imaging (MRI) of the brain at onset of the most recent ICH (Fig. 1A-D) showed acute left anterolateral temporal lobar hemorrhage with intrinsic isointense T1 signal and mild local mass effect, late subacute left posterior temporal-occipital lobar hemorrhage with intrinsic hyperintense T1 signal and enhancement on postcontrast images, and chronic right posterior temporal-occipital lobar hemorrhage with intrinsic hypointense T1 and T2 signal with encephalomalacia and surrounding gliosis on T2 FLAIR (fluid attenuated inversion recovery). Additional areas of peripherally distributed microhemorrhages and cortical superficial siderosis are present on T2* GRE (gradient echo, Fig. 1E), and white matter hyperintense lesions in multi-spot pattern are present in bilateral centrum semiovale on T2 FLAIR (Fig. 1F).
case_images: Humphrey visual field (HVF) demonstrating concomitant right homonymous hemianopsia and left-superior homonymous quadrantanopia secondary to cerebral amyloid angiopathy (CAA)-related intracranial hemorrhages.
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case_images: fig2
case_images: Humphrey visual field (HVF) 24-2 showed a mean deviation (MD) of -23.03 dB (dB) in the right eye (OD) and -26.69 dB in the left eye (OS) (Fig. 2).