SHM Converge Scientific Abstract ePoster Gallery-Cerebral Amyloid Angiopathy Related Inflammation: Importance of Early Detection

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This case describes an 85-year-old woman with dementia, diabetes, and hypothyroidism who presented to the emergency department with acute altered mental status. She was hypertensive and had bilateral foot skin changes suggestive of cellulitis, but initial labs were unremarkable and there was no clear infection. Head CT showed only age-related changes, but brain MRI revealed multiple foci of remote hemosiderin deposition and asymmetric parenchymal edema, findings consistent with cerebral amyloid angiopathy-related inflammation (CAA-ri).<br /><br />CAA-ri is an inflammatory subtype of cerebral amyloid angiopathy thought to be driven by an autoimmune response to amyloid-beta in the cerebrospinal fluid. Unlike typical CAA, which is more often associated with hemorrhagic stroke, CAA-ri commonly presents with rapidly progressive cognitive decline, confusion, or other neurologic symptoms. Diagnosis is now primarily based on clinical features plus MRI findings, reducing the need for biopsy. In this case, the patient’s presentation met criteria for probable CAA-ri.<br /><br />She was treated with a 5-day course of intravenous methylprednisolone with a planned outpatient steroid taper, along with IV cefazolin for possible non-purulent cellulitis. After treatment, she returned to her cognitive baseline and was discharged with neurology follow-up.<br /><br />The case highlights the importance of early recognition of CAA-ri as a potentially reversible cause of acute altered mental status, especially in older patients with underlying dementia or Alzheimer’s disease. Prompt treatment with high-dose corticosteroids can lead to significant symptom improvement.

Asset Subtitle

Kayleigh K. Butler

Meta Tag

Author List Kaitlyn Seibold, Kayleigh K. Butler, Morgan Lucero, Pinky Jha

Category Clinical Vignettes

Concept Cerebral Amyloid Angiopathy-Related Inflammation

Concept Altered Mental Status

Concept Rapidly Progressive Dementia

Concept Magnetic Resonance Imaging

Concept White Matter Hyperintensity

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Kayleigh K. Butler

Track Adult

Keywords

cerebral amyloid angiopathy-related inflammation

CAA-ri

altered mental status

dementia

MRI findings

hemosiderin deposition

parenchymal edema

corticosteroid treatment

acute confusion

reversible cognitive decline

Cerebral Amyloid Angiopathy-Related Inflammation

Altered Mental Status

Rapidly Progressive Dementia

Magnetic Resonance Imaging

White Matter Hyperintensity