DIAGNOSIS PLEASE Case 159（结果：脑淀粉样血管病相关性炎）

Mario Savoiardo, MD, Alessandra Erbetta, MD, Guido Storchi, MD and Floriano Girotti, MD
+ Author Affiliations

1From the Departments of Neuroradiology (M.S., A.E.) and Neurology (G.S., F.G.), Istituto Nazionale Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
Address correspondence to
M.S. (e-mail: msavoiardo@istituto-besta.it).

History
A 76-year-old man presented to the outpatient neurology service with fatigue and confusion of several months duration. His wife had recently noticed that he also had some memory impairment. The patient was a dental technician and was still active at work. He had mild hypertension. The only medication he was taking was aspirin (100 mg per day). At presentation, his systolic blood pressure was 160 mm Hg, and his diastolic blood pressure was 80 mm Hg. Funduscopic examination revealed mild arterial narrowing and sclerosis. The patient was alert and perfectly oriented. His Mini-Mental State Examination score was 27 (25.3 after correction for age and education), with some failure on memory tasks. The rest of the neurologic examination was normal. The results of routine blood tests performed at presentation were normal. The erythrocyte sedimentation rate; levels of C-reactive protein and extractable nuclear antigen, lupus anticoagulant, and anticardiolipin antibodies; and prothrombin and partial thromboplastin times were normal. Serum protein electrophoresis findings were negative. This patient was considered to have mild cognitive impairment (amnestic type) and was referred for brain computed tomography (CT) (Fig 1), which was followed the next day by 0.5- and 1.5-T magnetic resonance (MR) imaging (Figs 2–4).

76岁，男，因疲乏、意识混乱数月，到我院神经科门诊就诊。其妻子最近注意到他记忆力下降。该患者系一牙科技师，目前仍在岗。血压轻度升高。仅服用过阿司匹林（100mg/每天）。目前，其血压为160/80mm Hg，眼底镜检示轻度动脉狭窄、硬化。患者神志清楚，定向正常。简短精神状态检查得分为27分（根据年龄与受教育情况矫正后为25.3分），记忆力稍有障碍。余神经检查未见明显异常。血常规正常。血沉、C反应蛋白、可提取核抗原、狼疮抗凝物、抗心肌磷脂抗体、凝血酶原和部分凝血致活酶时间均正常。血清蛋白电泳阴性。该患者被诊断患有轻度认知障碍（遗忘型），行脑部CT检查（图1）。次日，行0.5T及1.5T核磁检查（图2－4）。
CT平扫



(a) Axial T2-weighted (repetition time msec/echo time msec, 2219/90) and (b) coronal fluid-attenuated inversion-recovery (repetition time msec/echo time msec/inversion time msec, 5000/120/1900) 0.5-T MR images.
轴位T2WI、冠状位FLAIR



(a) Diffusion-weighted 1.5-T MR image (b value, 1000 sec/mm2). (b) Apparent diffusion coefficient map. (c) Perfusion cerebral blood volume map obtained at the level of lateral ventricles.
DWI、ADC图、脑血流灌注量地图



Axial gradient-echo 1.5-T MR images (746/26, 20° flip angle) obtained at the level of the (a) lateral ventricles, (b) centrum semiovale, and (c) cranial frontoparietal regions.