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When stopping the antiplatelet drugs stopped the ‘TIAs’
  1. H C A Emsley1,
  2. J Kowalewska-Zietek1,
  3. R S Gulati2,
  4. S Wuppalapati3
  1. 1Department of Neurology, Royal Preston Hospital, Preston, UK
  2. 2Stroke Services, Blackpool Victoria Hospital, Blackpool, UK
  3. 3Imaging Directorate, Royal Preston Hospital, Preston, UK
  1. Correspondence to Dr Hedley Emsley, Consultant Neurologist, Department of Neurology, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston PR2 9HT, UK; h.emsley{at}liv.ac.uk

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Introduction

A 70-year-old woman reported recurrent episodes of right- or left-sided sensorimotor disturbance, thought to be recurrent transient ischaemic attacks. The episodes continued despite treatment with antiplatelet agents. When MRI revealed microhaemorrhages and focal superficial cortical haemosiderin deposition, antiplatelet agents were discontinued and her transient focal neurological episodes stopped. The imaging appearances suggested cerebral amyloid angiopathy (CAA) associated with superficial siderosis—although fulfilling criteria only for ‘possible CAA’. The case highlights the diversity of transient focal neurological episodes and the difficulties in current terminology and understanding of the clinical manifestations of CAA.

Case report

A 70-year-old woman presented in 2007 with episodes of left- or right-sided paraesthesiae, which would gradually spread over the affected side, sometimes associated with difficulty in walking, or episodes of expressive dysphasia with sensory disturbance in the mouth or tongue. The attacks typically evolved over several minutes and lasted up to 30 min. They occurred up to three times a week over an 18-month period. She had no significant medical history, nor any relevant family history. Her general practitioner had started aspirin after the first episode in August 2007; dipyridamole had subsequently been added at the local transient ischaemic attack (TIA) clinic. However, the events became more frequent and severe.

She scored 95/100 on the Addenbrookes Cognitive Examination-Revised (ACE-R). Carotid Doppler ultrasound studies found no significant extracranial precerebral arterial stenoses. Interictal EEGs demonstrated bitemporal epileptiform changes, with frequent irregular slow wave activity with sharp components in the middle to anterior temporal region bilaterally.

In early 2009, an MR brain scan showed a small (1.3 cm) intraparenchymal haemorrhage in the right parietal lobe. Further MRI with gradient …

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