Utilidad de las secuencias potenciadas en susceptibilidad paramagnética (SWI) para diferenciar crisis somestésicas de accidentes isquémicos transitorios en un paciente con angiopatía amiloide cerebral

Abstract

Background. Cerebral amyloid angiopathy (CAA) is characterized by the deposit of β-amyloid on the walls of small and medium-sized arteries of the cerebral cortex and leptomeninges causing cerebral bleeding. Clinical presentations may include transient neurological events for which differential diagnosis can be difficult. Case report. We report a subject with a medical history of recent stroke who presented somesthetic seizures mimicking transient ischemic attacks owing to CAA microbleeding. Antiplatelet treatment was reduced and after lamotrigine was commenced the episodes disappeared. Susceptibility-weighted magnetic resonance imaging was very helpful for diagnosis (SWI-MRI). Conclusions. CAA microbleeding can be manifested in the form of seizures mimicking focal transient sensitive neurological deficits that can be erroneously attributed to cerebral ischemia. The present case report suggests that, despite the presence of a past medical history of strokes, neurologists should consider CAA microbleeding as a possible cause of pseudo-transient ischemic attacks. High-resolution neuroimaging including SWIMRI imaging can be helpful in identifying cortical microbleedings. In this way, the start or increase of antiplatelet treatment can be avoided, and the risk of potentially fatal complications minimized.