Transient focal neurological episodes - “amyloid spells”: a TIA mimic that should be recognized

Abstract

A 74-year-old woman was admitted to our hospital with a history of episodes of left-sided hemiparesis and numbness for few minutes. A brain MRI showed cortical subarachnoid blood and diffuse cortical microbleeds, compatible with a diagnosis of cerebral amyloid angiopathy, according to modified Boston criteria 1. Other possible causes of the MRI findings, such as coagulopathy and traumatic brain injury, were excluded. Cerebral amyloid angiopathy, a common cause of lobar hemorrhage in older patients, can also present with transient focal neurological episodes, which are sometimes known as ' amyloid spells'. These are stereotyped, recurrent, transient episodes of numbness or weakness and may mimic a transient ischemic attack 1,2,3,4,5 .

Transient Focal Neurological Events in Cerebral Amyloid Angiopathy and the Long-term Risk of Intracerebral Hemorrhage and Death

“…However, recent evidence shows a more varied and complex symptoms that includes positive and negative symptoms, with or without a clear spreading pattern, that can last up to several hours . Hence, TFNEs can mimic other neurological disturbances, such as transient ischemic attacks (TIAs), migraine auras, or focal seizures …”

“…2 Hence, TFNEs can mimic other neurological disturbances, such as transient ischemic attacks (TIAs), migraine auras, or focal seizures. [3][4][5] Recent articles 6,7 have highlighted the importance of TFNEs in the natural history of CAA. The neuroimaging correlates of TFNEs have been extensively studied, showing a precise anatomical correlation between clinical presentation and the location of convexity subarachnoid hemorrhage (CSAH) and cortical superficial siderosis (CSS).…”