Abstract Details

Title Acute Bilateral Lower Extremity Weakness Due to Spinal Cord Hematoma Secondary to Amyloid Angiopathy: A Case Report

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-005

Objective NA

Background

Cerebral amyloid angiopathy (CAA), is an age-related neurological disease characterized by deposition of amyloid beta proteins in cerebral blood vessels walls, causing vessels fragility and increased risk of hemorrhagic events. Prevalence of CAA varies with age with 5-9% among individuals aged 60-69 years, 43-58% in patients above 90 years, and up to 90% in Alzheimer disease patients. However spinal cord amyloid angiopathy (SCAA) is extremely rare, with very few cases documented in the literature. Here we report a unique case of spinal cord hematoma secondary to amyloid angiopathy, presenting as acute onset of lower extremity weakness in an elderly patient.

Design/Methods NA

Results 78 Years old female with unremarkable past medical history, presented with acute onset of back pain, bilateral Lower extremities weakness more on the left side and gait imbalance, with no history of trauma or recent falls and otherwise neurologically intact. Brain MRI showed subacute 14 mm left frontal intraparenchymal hematoma, scattered cortically located chronic microhemorrhages in both cerebral hemispheres with no evidence of acute infarction. Radiological findings are consistent with CAA, but still not explaining patient’s clinical presentation. MRI thoracic and lumbar spine showed spinal cord hemorrhage at the level of T11 and T12 without underlying lesions or vascular malformation. Radiological findings of the brain and spinal cord in the absence of trauma or anticoagulation made spinal cord amyloid angiopathy (SCAA) the main cause of spinal cord hematoma. Conservative treatment with blood pressure control, physical therapy, and avoiding unnecessary blood thinners resulted in improvement of motor power to baseline over a period of six weeks.

Conclusions This case highlights the possibility that neurological deficits caused by spinal cord hematoma secondary to SCAA can be the first presentation in patient with cerebral amyloid angiopathy and underscores the need of further research for better understanding of this disease.

Authors/Disclosures
Emina Dzafic PRESENTER	Ms. Dzafic has nothing to disclose.
Hesham Kelani, MD (One Brooklyn Health)	Dr. Kelani has nothing to disclose.
Ahmed Abd Elazim, MD (Sanford USD Medical Center)	Dr. Abd Elazim has nothing to disclose.
Lauren V. Hatcher, MD (UNMH)	Dr. Hatcher has nothing to disclose.
Srikanth Adidam Venkata, MD (SUNY Downstate At One Brooklyn Health - Brookdale Hospital)	Dr. Adidam Venkata has nothing to disclose.
Selvalakshmi Rathinavelu, MD, MBBS (SUNY Downstate At One Brooklyn Health - Brookdale Hospital)	Dr. Rathinavelu has nothing to disclose.
Nataly Mor, MD (SUNY Downstate At One Brooklyn Health - Brookdale Hospital)	Nataly Mor, MD has nothing to disclose.
Artem Sunik, MD (Brookdale University Hospital Medical Center)	Dr. Sunik has nothing to disclose.
Amit Khaneja, MD (Amit Khaneja Neurology Practice PLLC)	Dr. Khaneja has nothing to disclose.
David P. Lerner, MD (One Brooklyn Health)	Dr. Lerner has received publishing royalties from a publication relating to health care.
Lisa R. Merlin, MD, FAAN (SUNY Downstate Medical Center)	Dr. Merlin has nothing to disclose.
Diana Greene-Chandos, MD, FAAN (St. Louis University SOM/SSM Health, Dept of Neurology)	Dr. Greene-Chandos has nothing to disclose.

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