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Progressive dementia and gait disorder in a 78 year old woman
  1. Department of Medicine for the Elderly, Tameside General Hospital, Fountain Street, Ashton under Lyne, OL6 9RW, UK

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    Although the provisional diagnosis of gliomatosis cerebri in the clinicopathological case conference by Tagliati et al was the one eventually validated at necropsy,1 the discussion should also have entertained the possibility that the occurrence of signal hyperintensity on MRI, in the context of dementia, ataxia, and Babinski's sign could also be consistent with the diagnosis of cerebral amyloid angiopathy (with giant cell inflammatory reaction to B4-amyloid and vasculitis), exemplified by a 63 year old man presenting with some of these stigmata.2 In the classic triad, consisting of cognitive impairment, upper motor neuron signs, and lobar haemorrhage,3 the third might well be a criterion potentially interchangeable with, or antedated by amyloid related vasculitis and attendant stigmata such as focal non-specific hyperintensity on MRI.