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Minimally symptomatic cerebral amyloid angiopathy-related inflammation: three descriptive case reports
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  • Published on:
    Response to a letter by Dr. G. Banerjee
    • Filipa Ladeira, Neurology Resident Neurology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental
    • Other Contributors:
      • Raquel Barbosa, Neurology Resident
      • Luisa Alves, Neurology Consultant
      • Miguel Viana-Baptista, Neurology Consultant

    We read with great interest the recent report of Banerjee and colleagues of three cases of minimally symptomatic cerebral amyloid angiopathy-related inflammation (CAA-ri) cases, drawing attention to the possibility of a wider spectrum of clinical manifestations in patients with CAA-ri than previously described1.
    Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a rare form of meningoencephalitis, presenting acutely with cognitive decline, seizures, headache and /or encephalopathy in most patients. The prognosis is poor even in patients under immunosuppressive treatment, with a mortality rate of 30% and only a minority of patients making a full recovery2-3. However, in the three cases reported by Banerjee and colleagues, patients presented with mild symptoms despite the magnitude of the MRI findings and made a full clinical and radiologic recovery in 2 of the cases with immunosuppressant treatment and in the remaining without any treatment.
    We have recently evaluated a similar patient, that presented with mild transient symptoms in whom the diagnosis was made following the finding of characteristic CAA-ri changes in brain MRI.
    He was a 62 year-old-man with a past history of hypertension, who was referred to the Emergency Department (ER) due to moderate frontal headache followed by left hemisensory numbness with Jacksonian march lasting a few minutes. He was asymptomatic on arrival at the ER and his neurological examination was normal. He perfor...

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    Conflict of Interest:
    None declared.