case_images: PMC10666051_01
case_images: Timeline of the clinical presentation, relevant diagnostic and therapeutic interventions. CAA-ri: cerebral amyloid angiopathy-related inflammation, GPA: granulomatosis with polyangiitis, MRI: magnetic resonance imaging. Figure created in BioRender.com.
case_images: fneur-14-1277843-g001.jpg
case_images: PMC10666051_01_fneur-14-1277843-g001.jpg
case_images: fig1
case_images: The patient was admitted for inpatient treatment including lumbar puncture as well as repetition of MR tomography (Figure 1). Around the 2000s, the patient had undergone appendectomy and ovariectomy due to ruptured mucinous cystic neoplasia in the mesentery (Figure 1).
case_images: MRI scans during the clinical course. MRI scans of the patient at admission (24/11/2022; upper row), during corticosteroid treatment (08/12/2022; middle row) and in clinical follow-up in March 2023 (21/03/2023; lower row). Images were acquired (from left to right) in the SWI, FLAIR, DWI (b value = 1,000 s/mm2) and contrast-enhanced T1 sequence. At admission, the left frontotemporal region shows a pronounced frontotemporal edema (blue arrows) with significant reduction under corticosteroid treatment and complete regression in the clinical follow-up 03/2023. The SWI sequence shows microhemorrhages (yellow arrowheads) as a sign of newly diagnosed CAA-ri.
case_images: fneur-14-1277843-g002.jpg
case_images: PMC10666051_01_fneur-14-1277843-g002.jpg
case_images: fig2
case_images: CAA-ri based on the clinicoradiological diagnostic criteria established by Auriel et al. (Figure 2, upper row). Corresponding to the CSF changes and clinical improvement, an MRI control scan preceding discharge in 12/2022 showed mild regression of the frontotemporal edema and perivascular contrast enhancement (Figure 2, middle row). Subsequent follow-up after discontinuation of cyclophosphamide treatment in 03/2023 demonstrated an almost complete regression of cerebral lesions (Figure 2, lower row).