PMC3644794_01
Computed tomography (CT) of the brain, magnetic resonance imaging (MRI) of the brain and spine images. CT showing right frontotemporal hematoma (a, arrow) with subarachnoid (SAH) hematoma (a, arrowhead). CT showing old hematoma and new areas of SAH on the left side (b, arrows). MRI showing subacute hematoma (c, arrowhead) and superficial cortical siderosis (c, arrows). MRI spine showing sacral intrathecal blood (d, arrow). MRI brain showing superficial cortical siderosis (e, arrows) and intraventricular blood (f, arrow). CT showing convexial SAH (g, arrows). SWI image showing siderosis in the supratentorial regions (h)
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F1
Computed tomography (CT) of the brain showed right frontotemporal ICH with SAH in the right sylvian fissure and temporal region [Figure 1a]. CT brain done after 10 days showed SAH in the parietal, frontal and temporal regions [Figure 1b]. Superficial cortical hemosiderosis was seen in the parasagittal region on both sides [Figure 1c]. She gradually improved with residual deficits (word finding difficulty and left facial paresis). MRI spine showed subacute hemorrhages, intrathecal at the S1-2 level, along the anterior surface of the cord at the L1-L2 level and along the filum terminale at the L4-S1 level [Figure 1d]. MRI brain showed bifrontal and right temporal gliotic areas with superficial hemosiderosis [Figure 1e]. May 2009, she came with progressive altered sensorium. MRI brain showed ventricular dilatation with IVH in the occipital horns [Figure 1f]. Subsequent brain CT/MRI scans showed evidence of recurrent convexity SAHs in different locations [Figure 1g] with progressive superficial hemosiderosis [Figure 1h].
Histopathology image. Leptomeningeal vessels showing thickening of the walls due to amyloid deposits, which stained positive with Congo red and showed apple-green birefringence (thick arrow). Amyloid plaques were also seen (thin arrow). (Images magnification - 10x)
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F2
Right frontal lobe biopsy showed thickened small-/medium-sized meningeal vessels, containing Congo red positive, birefringent, immunofluorescent amyloid material within the tunica media and adventitia [Figure 2].