Angela Xia, Vishal Mehta, Victoria Wei, Alexander Andreev, Robert Regenhardt
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Abstract
This case describes a 76-year-old male with initial clinical concern for a high-grade glioma, who was ultimately diagnosed with cerebral amyloid angiopathy-related inflammation The patient's presentation included a tonic-clonic seizure followed by aphasia and right-sided hemiparesis. Magnetic resonance brain imaging demonstrated a large left frontal lesion with parenchymal contrast enhancement. Magnetic resonance spectroscopy indicated elevated choline to creatine and choline to N-acetyl aspartate ratios, further suggestive of high-grade glioma. However, subsequent biopsy findings revealed perivascular amyloid deposits, confirming the diagnosis of CAA-ri. To our knowledge, this is the first case in literature to report elevated choline to creatine and choline to N-acetyl aspartate ratios in cerebral amyloid angiopathy-related inflammation.
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