Cerebral amyloid angiopathy with unilateral hemorrhages, mass effect, and meningeal enhancement

Cerebral amyloid angiopathy (CAA) is characterized by the deposition of amyloid in the walls of leptomeningeal and cerebral cortical arteries. The classic clinical features of CAA include recurrent hemorrhages in the cerebral cortex and subcortical white matter, often accompanied by dementia.1 We describe a 71-year-old man with CAA who presented with an unusual constellation of recurrent unilateral cerebral hemorrhages, mass effect, and meningeal enhancement on MRI. The patient is a 71-year-old, right-handed man who awoke with a headache and mild weakness of his right arm. Brain CT revealed a 1-cm hyperdensity in the left superior posterior frontal lobe, compatible with a focal hemorrhage. On follow-up 4 months later, MRI showed resolution of the left frontal hematoma and contrast enhancement in the left occipital lobe. An additional MRI performed 1 month later showed mass effect in the left occipital lobe, as well as new meningeal enhancement in the left temporal, parietal, and occipital lobes (figure, A). Gradient recall echo …