What Is Your Diagnosis? Received: August 12, 2014 Accepted: August 24, 2014 Published online: January 13, 2015 Eur Neurol 2015;73:171–172 DOI: 10.1159/000367843 An Elderly Patient with Recurrent Episodes of Hemi-Paresthesia Sung H. Ahn Jae H. Lee Jong S. Kim Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea nance imaging (MRI) of the brain showed no abnormalities (not shown). Sequential T2*-gradient echo (GRE) images revealed a progressively enlarged area of superficial siderosis on the right fronto-temporo-parietal cortex from 2009 to 2012 (fig. 1). Question A 71-year-old man presented with recurrent episodes of paresthesia in the left limb and face that lasted for a few minutes. Plain and gadolinium-enhanced magnetic reso- Fig. 1. T2*-gradient echo MRI shows progressively worsening superficial siderosis on the right frontoparietal cortices (a 2009; b 2011; c 2012). a © 2015 S. Karger AG, Basel 0014–3022/15/0734–0171$39.50/0 E-Mail karger@karger.com www.karger.com/ene What is your diagnosis? b c Jong S. Kim, MD, PhD Department of Neurology University of Ulsan College of Medicine, Asan Medical Center 388–1 Pungnap-dong, Songpa-gu, Seoul 138–736 (Korea) E-Mail jongskim @ amc.seoul.kr Downloaded by: Selçuk Universitesi 193.255.248.150 - 2/2/2015 7:05:31 PM Key Words Amyloid angiopathy · Sidersosis · PIB-PET Color version available online Fig. 2. 11C-Pittsburgh compound B (PIB)PET image shows increased PIB uptake throughout the cerebral cortex. Answer Disclosure Statement 172 Eur Neurol 2015;73:171–172 DOI: 10.1159/000367843 We have no disclosures to declare. References 1 Charidimou A, Baron JC, Werring DJ: Transient focal neurological episodes, cerebral amyloid angiopathy, and intracerebral hemorrhage risk: looking beyond TIAs. Int J Stroke 2013;8:105–108. 2 Ly JV, Donnan GA, Villemagne VL, Zavala JA, Ma H, O’Keefe G, Gong SJ, Gunawan RM, Saunder T, Ackerman U, Tochon-Danguy H, Churilov L, Phan TG, Rowe CC: 11C-PIB binding is increased in patients with cerebral amyloid angiopathy-related hemorrhage. Neurology 2010;74:487–493. Ahn/Lee/Kim Downloaded by: Selçuk Universitesi 193.255.248.150 - 2/2/2015 7:05:31 PM Cerebral angiography, EEG monitoring, CSF study, autoimmune and coagulopathy tests were all within normal limits. 11C-Pittsburgh compound B (PIB)-PET showed diffuse cortical amyloid deposits (fig. 2), a finding consistent with cerebral amyloid angiopathy (CAA). CAA is a small vessel disease characterized by the progressive deposition of amyloid-b protein in the walls of cortical and leptomeningeal vessels. Although the most widely recognized clinical presentation is lobar hemorrhages in old individuals, CAA may manifest as transient, recurrent, stereotyped, and brief (usually <30 min) episodes of focal neurologic symptoms [1]. The underlying mechanisms remain uncertain but may include cortical spreading depression or focal seizures. Although definite diagnosis of CAA requires surgical biopsy, PIB-PET helps us make a diagnosis in vivo [2].