Inflammation in Cerebral Amyloid Angiopathy-Related Transient Focal Neurological Episodes

Amina Sellimi; Larysa Panteleienko; Dermot Mallon; Simon Fandler-Höfler; Rupert Oliver; Victoria Harvey; Michael S Zandi; Gargi Banerjee; David J Werring

doi:10.1002/ana.27164

Inflammation in Cerebral Amyloid Angiopathy-Related Transient Focal Neurological Episodes

Ann Neurol. 2025 Jan 8. doi: 10.1002/ana.27164. Online ahead of print.

Authors

Amina Sellimi^{1

2}, Larysa Panteleienko¹, Dermot Mallon³, Simon Fandler-Höfler^{1

4}, Rupert Oliver³, Victoria Harvey³, Michael S Zandi⁵, Gargi Banerjee^{3

6}, David J Werring^{1

3}

Affiliations

¹ UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institue of Neurology, London, UK.
² Department of Neurology, Cliniques Universitaires Saint-Luc; Institute of Neuroscience, UCLouvain, Brussels, Belgium.
³ National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK.
⁴ Department of Neurology, Medical University of Graz, Graz, Austria.
⁵ Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK.
⁶ MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK.

PMID: 39777804
DOI: 10.1002/ana.27164

Abstract

Transient focal neurological episodes (TFNE), often associated with convexity subarachnoid hemorrhage (cSAH), are common in cerebral amyloid angiopathy (CAA), but their pathophysiology remains incompletely understood. In six patients with unremitting TFNE, using high-resolution post-contrast magnetic resonance imaging and vessel wall imaging (VWI), we found various combinations of transient leptomeningeal, parenchymal and vessel wall enhancement; in 5 of 6 the enhancement included regions corresponding anatomically to symptoms. Three patients had resolution of TFNE and enhancement (2 with corticosteroid treatment, 1 without). Our observations suggest that inflammation might contribute to the pathophysiology of CAA-related TFNE and cSAH, with potential wider relevance for the associated high risks of recurrent ICH in CAA more generally. ANN NEUROL 2025.