PMC4289971_01
Post-gadolinium T1-weighted MR images of the cervical spine (a, b) and brain (c), demonstrating diffuse, mildly nodular leptomeningeal enhancement over the surface of the spinal cord, brain stem and cerebellum (arrowheads)
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Fig1
Magnetic resonance imaging (MRI) of the brain and spine showed extensive leptomeningeal enhancement over the surface of the brain and spinal cord (Fig. 1).
Axial T2-weighted MR images of the lumbosacral spine (a, b), demonstrating mild hypertrophy of the spinal nerve roots. Mild prominence of the lumbosacral plexus bilaterally is also shown (arrows). Note the distended urinary bladder with a trabeculated wall (asterisk)
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Fig2
There was also evidence of mild, diffuse thickening of the intrathecal nerve roots, and nerves of the brachial and lumbosacral plexus (Fig. 2).  
Brain biopsy of meningeal and cerebral amyloid angiopathy Haematoxylin-Eosin stained sections (a and b) show thickened brightly eosinophilic walls of small vessels in the leptomeninges (blue arrowhead in a), neocortex (red arrowhead in a) and pachymeninges (black arrowhead in b). Affected vessels are positively stained with Congo red (c and d) which shows apple green birefringence under polarised light (e). Ultrastructural assessment (f) confirms the presence of haphazardly arranged amyloid fibrils in the dura mater (blue arrowhead). TTR protein (G) is widely deposited in the walls of the blood vessels and in addition shows patchy parenchymal deposits with a subpial distribution. A small proportion of the vessels in brain parenchyma also contain amyloid beta deposits (H) likely to represent co-localization of entrapped amyloid beta protein. Scale bar 100 microm (a-d); 30 microm (e); 0.5 microm (f); 50 microm (g-h)
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Fig3
There was no evidence of underlying malignancy or vasculitis. (see Fig. 3). 