PMC10196053_01
Brain biopsy. Old infarct with foamy macrophages and giant cells; blood vessels with hyaline thickening (H&E, Left 100x, top right 200x magnification). Bottom right, Beta amyloid positivity in vessel walls (IHC, Beta amyloid; 100x magnification).
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F1
Subsequent to the second ICH she underwent a brain biopsy which revealed CAA (Figure 1).
Clinical and radiological timeline overview.
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F2
Intensive investigation allowed collation of nearly two decades of MRI data for review (Figure 2).
Progressive evolution of the imaging features of CAA between 2006 (20 years post-exposure) and 2018 (33 years post-exposure) when the first ICH occurs. Top row demonstrates progressive periventricular white matter hyperintensity development. Red arrows indicate areas of cortical superficial siderosis. Blue arrows indicate enlarged perivascular spaces within centrum semi-ovale.
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F3
These scans demonstrated a marked progressive increase in periventricular WMH and multifocal cSS remote from the surgical site from 2014 onwards, disproportionate with age, vascular risk factors and past neurosurgery (Figures 3, 4).
Progressive changes within the posterior fossa, mistaken for post-operative change as scans from 2014 were not correlated with prior imaging. Blue arrows indicate enlarged cerebellar folia, apparent from 2014 onwards. Red arrows indicate superficial siderosis which progresses from 2014.
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F4
These scans demonstrated a marked progressive increase in periventricular WMH and multifocal cSS remote from the surgical site from 2014 onwards, disproportionate with age, vascular risk factors and past neurosurgery (Figures 3, 4).