Abstract Details

Title First Case of Successfully Treated Aß-related Angiitis After COVID-19 Infection

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P8 - Poster Session 8 (5:30 PM-6:30 PM)

Poster/Presentation
Number 9-003

Objective NA

Background Aβ-related angiitis (ABRA) is a cerebrovascular disorder characterized by angio-destructive amyloid beta-peptides that deposit in the walls of superficial cerebral vessels. Cerebral amyloid angiopathy (CAA) is a precursor to ABRA that is defined by the presence of inflammatory amyloid beta plaques. Here, we present a case of a 67-year-old female who, after a COVID-19 infection, experienced exacerbation of neurological symptoms leading to the detection of ABRA.

Design/Methods NA

Results A 67-year-old female with a history of hypertension and recent COVID-19 infection presented with generalized weakness and subacute encephalopathy. She stated that since her COVID-19 infection, she had been experiencing worsening headaches, memory loss, and lightheadedness. During her admission, she continued to decline and experienced a seizure. Initial work-up with brain MRI showed moderate deep and superficial white matter disease which maintained a broad differential. Lumbar puncture showed lymphocyte predominance with elevated protein raising concern for fungal infection. Biopsy of the right occipital lobe demonstrated gliotic brain tissue with foci of macrophage-rich parenchymal injury, moderate hemosiderin deposition and background-activated microglia with axonal injury. Pathology results with the characterization of the MRI of the brain aided in determining the diagnosis of amyloid angiopathy consistent with ABRA. The patient was started on one-gram of methylprednisolone daily for a five-day course. The patient showed dramatic improvement in cognition, strength, and mobility and was discharged with a long oral prednisone taper. A repeat MRI one month later continued to show extensive amyloidosis, but with stable clinical improvement.

Conclusions Our report details a rare case of a patient with ABRA after COVID-19 infection who was successfully treated. We hypothesize that the inflammatory reaction from COVID-19 can worsen CAA leading to ABRA. In patients with rapidly progressive post-COVID dementia, ABRA should be considered as a differential as it is a treatable disease and otherwise has a high mortality rate.

Authors/Disclosures
Emma C. Bagheri, DO (Loma Linda University Health - Murrieta) PRESENTER	Dr. Bagheri has nothing to disclose.
Evelyn Delgado	Miss Delgado has nothing to disclose.
Sina Bagheri, DO (Temecula Valley Hospital)	Dr. Bagheri has nothing to disclose.
Ricardo Olivo, MD (Innovative Neurology, Inc.)	Dr. Olivo has nothing to disclose.

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