Unusual causes of stroke – 2 cases of inflammatory amyloid angiopathy

Marigold, R and Ahmed, M. (2025) Unusual causes of stroke – 2 cases of inflammatory amyloid angiopathy. International Journal of Stroke, 20 (3S), 42. (doi:10.1177/17474930251379781).

Abstract

Introduction: Inflammatory cerebral amyloid angiopathy (iCAA) is a rare
cause of stroke. We present 2 cases of patients with recurrent stereotypical
symptoms despite optimum secondary prevention therapy who went
on to have an inflammatory version of cerebral amyloid diagnosed.

Method: Two patients presented to University Hospital Southampton in
early 2025, the first with recurrent episodes of confusion, visual loss and
cognitive decline, with subsequent MRI imaging showing further progression
of ischaemic changes and surrounding oedema in the left occipital
lobe despite dual antiplatelet, statin and antihypertensive medication and
the exclusion of significant intra and extracranial atheroma and a cardioembolic
source of stroke.

The second patient presented with three episodes of ascending numbness
and weakness from her right foot up her right leg resulting in transient
focal neurological events with a fall and a seizure, with MRI showing
left superior frontal gyrus white matter hyperintensities and surrounding
vasogenic oedema as well as multiple microbleeds, but then had further
ischaemic changes despite optimal secondary prevention.

Results or details of the case: Both patients went on to have further
investigations and were thought to have iCAA and were subsequently
treated with high dose prednisolone. We discuss investigation and management
in these interesting cases.

Conclusion: Inflammatory cerebral amyloid angiopathy, although rare,
should be considered when patients have recurrent stereotypical symptoms
that recur despite appropriate and even aggressive stroke secondary
prevention. Treatment with high dose corticosteroids and immunosuppression
follow once the diagnosis has been made.

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