Amyloid spells

A 66-year-old woman presented with a history of recurrent, transient neurologic symptoms including limb shaking, focal paresthesias, focal weakness, dysphasia, and unresponsiveness. The episodes showed no preference for time of day, lasted less than 6 minutes, and occurred less than monthly in small clusters, increasing in frequency slowly over 2 years. She lived independently, denied cognitive or other complaints, and had no history of smoking, hypertension, hyperlipidemia, coronary atherosclerosis or diabetes mellitus, or family history of stroke. Clinical examination was unremarkable. Cognition was grossly intact but not formally tested. Differential diagnosis included transient ischemic attacks (TIAs), seizures, and psychogenic nonepileptic seizures (PNESs). MRI of the brain was consistent with probable cerebral amyloid angiopathy (CAA) (figure) with cortical microbleeds and superficial siderosis.1,2 Two habitual transient focal neurologic episodes (TFNEs) were captured on video EEG (video 1).

Source: Neurology Clinical Practice - April 7, 2019 Category: Neurology Authors: Cooperman, S. S., Shah, A. K., Rajamani, K. Tags: Intracerebral hemorrhage Case Source Type: research