An obtunded previously healthy 60-year-old woman was intubated with a 2-week history of headaches and 1-month history of memory loss. MRI was performed (figure 1). Digital subtraction angiography of the head, varicella-zoster virus PCR, immunoglobulin G in the CSF, hepatitis B/C, CSF cryptococcal antigen, HIV, Lyme serology, and syphilis screen were negative. The initial differential diagnosis included CNS vasculitis and intracerebral lymphoma. She was diagnosed with inflammatory cerebral amyloid angiopathy based on clinicoradiologic criteria (which has a sensitivity of 82% and specificity of 97%),1 with infarction suggesting amyloid-β-related angiitis subtype. Within a few days of steroids, she was fully alert, and repeat MRI 5 months later showed improvement of leukoencephalopathy (figure 2). Montreal Cognitive Assessment scores were 23/30 2 weeks after initiation of therapy and 22/30 5 months later.

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