Bethesda, MD 20894, Web Policies doi: 10.1097/CM9.0000000000001427, This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. [14] Previous studies have revealed that, compared with multiple sclerosis and healthy people, anti-A autoantibodies in the CSF of CAA-RI patients increased during the acute phase, which is consistent with what was observed in ARIA, supporting the aforementioned hypothesis of an A-induced immune response. PMC Cerebral amyloid angiopathy (CAA) is a kind of disease in which amyloid (A) and other amyloid protein deposits in the cerebral cortex and the small blood vessels of the brain, causing . Szpak GM, Lewandowska E, Sliwiska A, Stpie T, Tarka S, Mendel T, et al. Giant cell arteritis and arteriolitis associated with amyloid angiopathy in an elderly mongol. 46. This site needs JavaScript to work properly. By definition, CAA is characterized by vessel wall amyloid deposits. Amyloid can be confirmed when the Congo red-stained section shows green birefringence under polarized light. Cheng AL, Batool S, McCreary CR, Lauzon ML, Frayne R, Goyal M, et al. Giant cell arteritis and arteriolitis associated with amyloid angiopathy in an elderly mongol. In the remainder, which accounts for 60% of all affected individuals, even with treatment severe disability or death are encountered 2. Cerebral amyloid--related angiitis without cerebral microbleeds in a patient with subarachnoid hemorrhage. Cerebral amyloid angiopathy with related inflammation (CAA-RI) is an uncommon inflammatory subtype of CAA, with a variety of presentations that can mimic other focal and diffuse neurological disorders. Aimen Moussaddy, Ariel Levy, Daniel Strbian, Sophia Sundararajan, France Berthelet, Sylvain Lanthier. It also remains unclear what should be done for those diagnosed with possible CAA-RI, and whether they still need to undergo brain biopsy. When the distinction is made, the difference lies in whether the inflammation is perivascular only (cerebral amyloid angiopathy-related inflammation or inflammatory cerebral amyloid angiopathy) or also involves and destroys the vessel wall (amyloid -related angiitis). When rapid progressive dementia occurs in people over 40 years of age, accompanied by headache, seizures, or focal neurological deficits, with patchy or confluent T2 or FLAIR hyperintensity and evidence of CMBs or cSS, a diagnosis of CAA-RI should be suspected. [22,31] In fact, both ICAA and ABRA can present with or without granulomatous inflammation. Cerebral Amyloid Angiopathy-Related Inflammation: A Single-Center Experience and a Literature Review. [Cerebral Amyloid Angiopathy-Related Inflammation/Vasculitis]. Medicina (Kaunas). [39] One patient with a history of Parkinson's disease (PD) was mistakenly thought to have developed the mental manifestation of PD when he presented with the symptoms of CAA-RI. You may be trying to access this site from a secured browser on the server. Corovic A, Kelly S, Markus HS. Coulette S, Renard D, Lehmann S, Raposo N, Arquizan C, Charif M, et al. Liang JW, Zhang W, Sarlin J, Boniece I. [47,60] In the future, the significance of these indicators for the differential diagnosis of CAA-RI mimics should be studied. -, Salvarani C, Hunder GG, Morris JM, Brown RD, Christianson T, Giannini C. A-related angiitis: comparison with CAA without inflammation and primary CNS vasculitis. Cerebrospinal fluid anti-amyloid- autoantibodies and amyloid PET in cerebral amyloid angiopathy-related inflammation. CAA-RI shares pathologic characteristics of CAA, which is A deposition in the cortical or leptomeningeal vessels, with positive Congo red staining. Imaging Findings of Cerebral Amyloid Angiopathy, A-Related Angiitis (ABRA), and Cerebral Amyloid Angiopathy-Related Inflammation: A Single-Institution 25-Year Experience. 44. Immunosuppressants can be administered in cases showing no response to glucocorticoids or for preventing recurrence. Wolters Kluwer Health The rare forms of inflammatory angiopathy attributed to A, A-related angiitis . doi: 10.1111/bpa.13061. 5. Amyloid beta-related angiitis--a case report and comprehensive review of literature of 94 cases. However, biopsy is invasive; consequently, some criteria for the diagnosis of CAA-RI have been based on clinical and radiological data. (2015) Stroke. A significant proportion of patients respond readily to treatment with corticosteroids, with or without a cytostatic agent,with improvement evident within a week or two of commencement of treatment. 8. These patients typically present with subacute mental status changes, headaches, and seizures, typically at a slightly younger age than those presenting with . 1-6 It differs from more common noninflammatory forms of CAA . [2527] ARIA is also divided into two categories: ARIA-E, which manifests as focal or confluent vasogenic edema on fluid-attenuated inversion recovery (FLAIR) sequence images, and ARIA-H, characterized by CMBs or cSS on T2-weighted gradient-echo/susceptibility-weighted imaging (SWI) sequence scans, corresponding to the image hallmarks of CAA-RI. Blechingberg J, Poulsen ASA, Kjlby M, Monti G, Allen M, Ivarsen AK, et al. 43. 30. Zhu X, Schrader JM, Irizarry BA, Smith SO, Van Nostrand WE. Sakai K, Ueda M, Fukushima W, Tamaoka A, Shoji M, Ando Y, et al. The diagnostic criteria for "probable" inflammatory cerebral amyloid angiopathy require white matter hyperintensities on T2-FLAIRthat are asymmetric and extend to the immediately subcortical white matter 4. The https:// ensures that you are connecting to the It would be more difficult to identify patients who also have a history of tumors. Curr Opin Neurol 2018; 31:2835. 2022 Jul;9(7):1102-1103. doi: 10.1002/acn3.51596. Association between immunosuppressive treatment and outcomes of cerebral amyloid angiopathy-related inflammation. Cerebral amyloid angiopathy is often asymptomatic, which can cause dementia, intracranial hemorrhage, or transient neurological events. Epub 2022 Aug 5. [55,56] Thus, 2 carriers may also be predisposed to CAA-RI. In addition, the treatment of infection and other comorbidities should be considered in such cases. Typical images of cerebral amyloid angiopathy-related inflammation. Renard D, Wacongne A, Ayrignac X, Charif M, Fourcade G, Azakri S, et al. The major clinical manifestations of CAA-RI are subacute mental disorders and behavioral or cognitive changes, headaches, seizures, and focal neurological deficits, which are different from CAA. Salvarani C, Morris JM, Giannini C, Brown RD Jr, Christianson T, Hunder GG. Anti-amyloid beta autoantibodies in cerebral amyloid angiopathy-related inflammation: implications for amyloid-modifying therapies. 19. Many diseases with similar clinical manifestations should be carefully ruled out. However, due to the relatively few 2 alleles or genotypes detected in cases, it is difficult to determine the role of 2 in CAA-RI in small sample studies. [17] And the youngest case with pathologic evidence ever reported was 42 years old.[34]. [14,29] Finally, in terms of clinical manifestations and prognosis, there was no difference between the two pathological subtypes of CAA-RI. Introduction Cerebral amyloid angiopathy-related inflammation: a case report presenting with a rare variant in SORL1 gene. Cerebral amyloid angiopathy (CAA) is a type of cerebrovascular disorder characterized by the accumulation of amyloid within the leptomeninges and small/medium-sized cerebral blood vessels. Since there is no A deposition in the blood vessels supplying the spinal cord, symptoms of myelopathy have not been reported in ICAA and ABRA; thus, PACNS is a more likely diagnosis when symptoms involving the spinal cord occur. The mechanism underlying CAA-RI remains unclear. Acute or subacute onset of cognitive decline or behavioral changes is the most common symptom of CAA-RI. Medicine (Baltimore). Table 4. doi: 10.1007/bf00687163. 2014 Aug;44(1):86-92. doi: 10.1016/j.semarthrit.2014.02.001. Other differential diagnoses include viral or autoimmune encephalitis, cerebral venous thrombosis, acute disseminated encephalomyelitis (ADEM), Hashimoto encephalopathy, neurosarcoidosis, and acute toxic-metabolic leukoencephalopathy. (A) Confluent WMH. Xu YY, Chen S, Zhao JH, Chen XL, Zhang JW. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 69. There are still many questions related to CAA-RI that require investigation. Biopsy obtained from the white matter showed no evidence of inflammation in one case. Abeta-related angiitis: primary angiitis of the central nervous system associated with cerebral amyloid angiopathy. Hainline C, Rucker JC, Zagzag D, Golfinos JG, Lui YW, Liechty B, et al. [67] For such patients, a clinicoradiological diagnosis only may result in missing a coexisting tumor, and thus the pros and cons of biopsy should be weighed carefully. The resultant vascular fragility tends to manifest in normotensive elderly patients as lobar intracerebral hemorrhage. 42. Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China. However, many patients present with atypical symptoms other than those mentioned above, which may easily lead to an incorrect diagnosis. [72] It is worth noting that this case involved a patient who had been using immunosuppressive agents. [18] However, these results should be carefully considered because the high proportion of granulomatous inflammation may be due to the higher biopsy rate in those cases showing more serious clinical and imaging manifestations and a tendency of malignant diseases.[22]. [15] In fact, these two types sometimes do coexist. Chinese Medical Journal134(6):646-654, March 20, 2021. CMBs: Cerebral microbleeds; WMH: White matter hyperintensity. The distribution of CMBs does not follow the regional pattern of occipital dominance in non-inflammatory CAA. 71. Unauthorized use of these marks is strictly prohibited. Cerebral amyloid angiopathy (CAA) is characterized by amyloid beta-peptide deposits within small- to medium-sized blood vessels of the brain and leptomeninges. Pathogenetical subtypes of recurrent intracerebral hemorrhage: designations by SMASH-U classification system. Early diagnosis and timely treatment may improve prognosis. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Sharma R, Deng F, et al. Abstract. There are two recognized pathologically characterized variants: cerebral amyloid angiopathy-related inflammation (CAAri) and A beta-related angiitis (ABRA). 15. Tumors including primary central nervous system lymphomas and metastases should be taken into consideration when making a diagnosis in such patients. [11] The gold standard test for diagnosis is autopsy or brain biopsy. This study was supported by a grant from the National Key Research and Development Program of China (No. Correspondence to: Dr. Jun Ni, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongdan, Dongcheng District, Beijing 10073, ChinaE-Mail: [emailprotected], How to cite this article: Wu JJ, Yao M, Ni J. Cerebral amyloid angiopathy-related inflammation: current status and future implications. 15 (8): 54. [46,47] A possible explanation for this finding is that, once an immune response to vascular amyloid protein is generated, it affects multiple regions of brain via the spread of antibodies. Acute ischemic lesions in cerebral amyloid angiopathy-related inflammation. Amyloid angiopathy is a condition in which amyloid peptides are deposited in vessel walls in the brain and meninges, with a pattern of "microbleeds" visible on MRI gradient echo imaging and a tendency for large, lobar intracerebral hemorrhages. However, given the segmental distribution of the lesions, they may be missed by the biopsy, which will lead to a missed diagnosis. 51 (2): 525-32. [9] Cells such as CD3+, CD4+, and CD8+ T lymphocytes, CD20+ B lymphocytes, and CD68+ monocytes, including macrophages (sometimes multinucleated giant cells) in the vessel wall and reactive astrocytes can be found in the surrounding parenchyma. Yamada M. Cerebral amyloid angiopathy: emerging concepts. (2016) Radiology. Diagnosis, treatment, and follow-up of patients with cerebral amyloid angiopathy-related inflammation. For more information, please refer to our Privacy Policy. Subcortical white matter will demonstrate usually a solitary area of low density with localized mass effect 1,2. Chin Med J 2021;134:646654. Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an unusual cause of encephalopathy, seizures and focal neurological deficits.1 2 We report three cases of CAA-ri with minimal symptoms but striking and dynamically evolving brain MRI findings. Pathological changes within the cerebral vasculature in Alzheimer's disease: New perspectives. CAA-RI consists of two subtypes: inflammatory cerebral amyloid angiopathy and amyloid (A)-related angiitis. The clinical manifestations of PACNS can also mimic the pattern of CAA-RI. 5. Cerebrospinal fluid, MRI, and florbetaben-PET in cerebral amyloid angiopathy-related inflammation. Miller-Thomas MM, Sipe AL, Benzinger TL et-al. [68] Other features include seizures, headaches, T2-weighted white matter hyperintense (WMH) lesions on magnetic resonance imaging (MRI), and pathological evidence of inflammation against vascular A, which is the hallmark of CAA. Disclaimer. [14] Based on the criteria of leptomeningeal enhancement, the sensitivity and specificity of recognizing CAA-RI from CAA patients are reported to be 70.4% and 92.6%, respectively. 50. [14] In addition to A deposition, CAA-RI also demonstrates pronounced perivascular or transmural inflammatory infiltration. Clinical history of progressive cognitive decline over a few weeks and asymmetrically grouped cerebral microbleeds with focal corticosubcortical FLAIR hyperintensity, untypical for stroke and without restricted diffusion, we suspected cerebral amyloid angiopathy related inflammation (CAA-RI). SWI or T2: which MRI sequence to use in the detection of cerebral microbleeds? [17] Multiple lobar CMBs were found on SWI or T2 images in most patients, but some cases of pathologically confirmed CAA-RI were without CMBs on MRI. Objective. [12,14,18] The erythrocyte sedimentation rate was increased in 37.5% of patients, while C-reactive protein (CRP) was elevated in 60%. The aim of future research should focus on specific pathogenic mechanisms and inflammatory pathways to determine which types of CAA patients are prone to developing inflammation, whether other genes or alleles besides APOE 4 are also risk factors, how they play a role in the mechanism, and so on. There is currently no long-term follow-up cohort to establish prognosis, and differences in prognoses associated with different therapies for different subtypes are worth investigating. Bogner S, Bernreuther C, Matschke J, Barrera-Ocampo A, Sepulveda-Falla D, Leypoldt F, et al. Thus, PACNS is on the list of differential diagnoses whenever multifocal hyperintensity is seen on FLAIR images, although it is a diagnosis of exclusion. [17] While another systematic review showed that the functional outcome of most patients was not ideal. [17] Steroid therapy is also effective during recurrence, but increased microbleeds may be detected with T2/SWI sequences in that case. 31. (B) Strictly lobar CMBs. Typical images of cerebral amyloid angiopathy-related inflammation. Ng DW, Magaki S, Terashima KH, Keener AM, Salamon N, Karnezis S, et al. Reid and Maloney first described CAA with vascular inflammation in a patient with AD in 1974, and subsequent cases were reported. Immunosuppressive therapy is effective both during initial presentation and in relapses. Federal government websites often end in .gov or .mil. Phrases such as CAA associated with inflammation, CAA-RI, ICAA, and ABRA are used interchangeably. Terminology Brain MRI lesions; Cerebral amyloid angiopathy; Cerebral small vessel disease; Inflammation; Review. Castro Caldas A, Silva C, Albuquerque L, Pimentel J, Silva V, Ferro JM. The use of glucocorticoids and immunosuppressants improves prognosis. 72. Brashear, H.M. Arrighi, K.A. [69] A systematic review of both pathological subtypes revealed that, during an average follow-up period of 24 months, 55% of patients eventually end up being asymptomatic or with mild disability. Perivascular and vascular inflammatory patterns without granulomas accounted for 22.5% of cases. 62. Child ND, Braksick SA, Flanagan EP, Keegan BM, Giannini C, Kantarci OH. [5] Unlike non-inflammatory CAA, acute or subacute onset of cognitive decline or behavioral changes are the most common symptom of CAA-RI. [57] A reduction of CMBs was found in one case after immunotherapy, but it cannot be ruled out that the natural course of CAA-RI may include a spontaneous reduction in CMBs. 37. Many studies have reported that APOE 4/4 homozygosity is significantly correlated with CAA-RI,[47] accounting for 76.9% of CAA-RI patients. Du Y, Liu C, Ma C, Xu X, Zhou X, Zhou H, et al. There are two recognized pathologically characterized variants: cerebral amyloid angiopathy-related inflammation (CAAri) and A beta-related angiitis (ABRA). The diagnostic criteria for possible or probable inflammatory cerebral amyloid angiopathy require at least one of the following clinical features that are not directly attributable to an acute intracerebral hemorrhage4: Some patients also present with hallucinations 2. [61] Despite this, negative brain biopsy findings are insufficient to exclude the diagnosis of CAA-RI, because of the segmental distribution of pathological changes. Brain MRI, particularly FLAIR and T2/SWI sequences, is the most important imaging modality for the identification of patients suspected of CAA-RI. (C) No enhancement was seen. Overall, it is believed that immunotherapy would result in better clinical outcomes in patients. Rarer, inflammatory forms (CAAi) are characterized by the presence of . Thirteen percent of patients were affected with some forms of visual impairment. Cerebral amyloid angiopathy is unrelated to generalized amyloidosis. A case of cerebral amyloid angiopathy-related inflammation with the rare apolipoprotein epsilon2/epsilon2 genotype. Some of these diseases can be ruled out by T2 MRI or SWI. Epub 2014 Feb 11. Epub 2014 Feb 11. 11. It may also be possible that, due to sampling error on biopsy,the pathological diagnosis does not reflect the global picture depicted on imaging 6. The clinical presentation is usually acute or subacute 1,2, but may be chronic4. [18] No difference in outcome was found between patients receiving mono-therapy of corticosteroid and patients receiving a combination of immunosuppressant and corticosteroid therapy. Cerebral Amyloid Angiopathy (CAA) Associated with Inflammation (Inflammatory CAA) Background: Cerebral amyloid angiopathy (CAA) is characterized by deposition of amyloid-beta in the media and adventitia of cortical and leptomeningeal arteries. Cerebral amyloid angiopathy (CAA) is an important cause of cognitive impairment and spontaneous intracerebral hemorrhage in the elderly. Epub 2022 Aug 5. [40] Whether the etiology of these comorbidities, such as autoimmunity, or their treatment, such as radiation therapy,[41] are related to CAA-RI requires further study. However, the prognosis of most untreated patients is poor. 2. Second, vasculitis and the vascular areas affected by A co-localize. [11] The most commonly used immunosuppressants are cyclophosphamide (33.9%), azathioprine (5.0%), mycophenolate mofetil (5.0%), methotrexate, immunoglobulin, and so on. 2019 Sep-Oct;42:36-40. doi: 10.1016/j.carpath.2019.05.004. 73 (2): 197-202. [19,29,30] Usually, B lymphocytes are fewer compared to T cells. Sporadic cerebral amyloid angiopathy (CAA) is a common age-related small vessel disease of the brain, characterized by progressive deposition of amyloid- peptide in the walls of small- to medium-sized arteries, arterioles, and capillaries of the cerebral cortex and overlying leptomeninges [ 1 ]. 11. In general, the same patient group affected by cerebral amyloid angiopathy is affected, and thus most patients are elderly, typically 60-80 years of age. Data is temporarily unavailable. Bookshelf 2. If only routine sequences are performed, it is easy to mistake WMH as the only image manifestation and consequently delay diagnosis and treatment. Many cases have reported that patients were misdiagnosed with tumors, and the diagnosis was modified to CAA-RI when the data were retrospectively analyzed or after the biopsy results became available. Cerebral amyloid angiopathy (CAA) is presented with progressive deposition of amyloid proteins within the cortical and leptomeningeal arteries, which is a common pathology in the elder [1, 2].In recent years, studies show that coexisting inflammations found in CAA patients, such as vasculitis or perivasculitis, have been recognized as CAA-related inflammation (CAA-ri) []. The most recent systematic review included 213 pathologically confirmed cases of CAA-RI. This pathological distinction is not reliably predicted on imaging 2. Pathogenetical subtypes of recurrent intracerebral hemorrhage: designations by SMASH-U classification system. These cases emphasize that CAA-RI is a diagnosis by exclusion. FOIA Thus, amyloid positron emission tomography (PET) might be important for the diagnosis of CAA-RI, by showing sites with markedly elevated amyloid deposition.[11,52,53]. Piazza F, Greenberg SM, Savoiardo M, et al. Cerebral amyloid angiopathy related inflammation with prominent meningeal involvement. Because of the similarity between CAA-RI and ARIA, the first theory seems unreasonable. Thus, it needs to be established whether excessive immune suppression would have an adverse effect on the long-term prognosis of patients. Radiographics. 57. 2022 Nov 14;11(22):6731. doi: 10.3390/jcm11226731. Our clinical experience also supports this conclusion [Figure 1]. There are also cases of CAA-RI patients reported with genotype APOE 2/2 and APOE 2/3. The .gov means its official. A is deposited segmentally, but can be found in all those inflammation sites. The Karolinska Imaging Dementia Study. [24] There are three current hypotheses: (1) coexistence of vascular A and vascular inflammation implies that A is a bystander of angiitis; (2) inflammation promotes accumulation of A in the vessel wall; (3) A deposition triggers the inflammatory response. In addition, CAA is a disease caused by disordered A clearance, and CAA-RI is in fact the body's immune response aimed at clearing A. Rajczewska-Oleszkiewicz C, Cyganek A, Stadnik A, Dziewulska D. Cerebral amyloid angiopathy-related inflammation - a case report presenting diagnostic difficulties. WMH and vasogenic edema accompanied by a mass effect make brain tumors a highly suspected differentiation. This is in most cases a non-inflammatory age-related condition that is associated with cerebral hemorrhage, infarcts, leukoencephalopathy and dementia. 12. Kang P, Bucelli RC, Ferguson CJ, Corbo JC, Kim AH, Day GS. Cerebral amyloid angiopathy and Alzheimer disease - one peptide, two pathways. 51. Kotsenas AL, Morris JM, Wald JT, Parisi JE, Campeau NG. The presence of symmetric white matter lesions that extend to the immediately subcortical white matter would only meet the criteria for "possible" inflammatory cerebral amyloid angiopathy 4. Stroke-Like Episodes Heralding a Reversible Encephalopathy: Microbleeds as the Key to the Diagnosis of Cerebral Amyloid Angiopathy-Related Inflammation-A Case Report and Literature Review. Biomedicines. Although CAA-RI is relatively rare at present, it may become more common in future with the improvement of diagnostic techniques. Auriel E, Charidimou A, Gurol ME, Ni J, Van Etten ES, Martinez-Ramirez S, et al. Cerebral amyloid angiopathy-related inflammation (CAAri) is characterized by vasogenic edema and multiple cortical/subcortical microbleeds, sharing several aspects with the recently defined amyloidrelated imaging abnormalities (ARIA) reported in Alzheimer's disease (AD) passive immunization therapies. Sengoku R, Matsushima S, Murakami Y, Fukuda T, Tokumaru AM, Hashimoto M, et al. Inflammatory cerebral amyloid angiopathy. Aghetti A, Sne D, Polivka M, Shor N, Lechtman S, Chabriat H, Jouvent E, Guey S. Cerebral Amyloid Angiopathy Related Inflammation With Prominent Meningeal Involvement. Epub 2019 May 25. [58,59] Thus, a variant in SORL1 may lead to dysfunction of SorLA, eventually adding to the risk of CAA-RI. 10: 984. This case was reminiscent of ANCA-associated vasculitis, although the relationship between proteinase 3-antineutrophil cytoplasmic antibody and the pathogenesis of CAA-RI remains unclear. [2023] In recent years, it has gradually come to be accepted that these two pathological types are essentially similar. Findings supporting CAA-RI include patchy or confluent T2 hyperintensity of subcortical white matter lesions, which are mostly asymmetric, in addition to the presence of multiple, strictly lobar CMBs and cSS on T2 or SWI, which is also a typical finding in CAA [Figure 1]. 32. Terminology Ann Clin Transl Neurol. [28] Antibody levels decrease after corticosteroid therapy,[2,42] indicating that anti-A autoantibody may be used as a biomarker for both diagnosis and monitoring the effect of treatment. Cerebrospinal fluid Alzheimer's disease biomarkers in cerebral amyloid angiopathy-related inflammation. Beta-APP42 may activate mononuclear phagocytes in the brain and elicit inflammatory responses. [22] Nevertheless, in our experience, this is not typical and may not be meaningful in clinical practice. Andersen OM, Rudolph IM, Willnow TE. [14] However, findings from another study have suggested that non-specific vascular changes in ABRA may be observed when medium-sized arteries are involved. 12. The work cannot be changed in any way or used commercially without permission from the journal. In the vast majority of cases (90%), microhemorrhages are present 1,2. Melzer N, Harder A, Gross CC, Wolfer J, Stummer W, Niederstadt T, et al. After treatment with corticoids, (D) WMH faded significantly. official website and that any information you provide is encrypted Leptomeningeal and parenchymal vessels should be scored separately. Growing numbers of patients have been reported with vascular inflammation associated with advanced cerebral amyloid angiopathy (59; 150). Nakaya M, Hashimoto H, Usui G, Sawada K, Shirouzu I, Oshima A, et al.

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