Clinical Reasoning: Rapid progression of reversible cognitive impairment in an 80-year-old man
Walid Bouthour, Lukas Sveikata, Maria Isabel Vargas, Johannes Alexander Lobrinus, Emmanuel Carrera
Neurology Dec 2018, 91 (24) 1109-1113; DOI: 10.1212/WNL.0000000000006647
Neurologyの研修医とフェロー向けの症例検討です．
今回は良く遭遇する高齢者の進行する意識障害！
Summary
- 高齢者の急速に進行する意識障害で，MRIで白質病変とMicro bleeds (MBs)がある症例では炎症性脳アミロイド血管炎(inflammatory cerebral amyloid angiopathy; CAA-I)を考慮する
- CAA-Iの診断基準
- (1) age >40 years
- (2) clinical symptoms, such as headaches or cognitive disturbances, not directly attributable to intracerebral hemorrhage
- (3) asymmetric WMD patterns that extend to the immediately subcortical area
- (4) presence of cortico–subcortical hemorrhagic lesions
- 脳の生検は診断に有用
Lesson for clinical setting
高齢者のよくわからない意識障害は遭遇します．MBsと白質病変があれば，CAA-Iも鑑別疾患に挙げるべきだと学びました．
