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Gastroenterology — UKMLA MCQ

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HardGastroenterologyUKMLAMRCP Part 1

A 74-year-old has three stereotyped episodes in which tingling spreads from the right fingers to the face over 4 minutes, followed by weakness lasting 15 minutes. CT is normal. MRI shows strictly lobar microbleeds and cortical superficial siderosis. What is the most appropriate interpretation?

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Correct answer: C — CAA-related transient focal neurological episodes with increased lobar haemorrhage risk

The best answer is “CAA-related transient focal neurological episodes with increased lobar haemorrhage risk”. The slow, stereotyped, spreading positive symptoms together with cortical superficial siderosis and strictly lobar microbleeds are characteristic of cerebral amyloid angiopathy-related transient focal neurological episodes. They predict a substantial future lobar intracerebral-haemorrhage risk and may reflect focal cortical irritation from convexity subarachnoid blood. Misclassifying them as thromboembolic TIAs and automatically adding antithrombotic treatment can therefore be hazardous; susceptibility-sensitive MRI findings are decisive.

Reference: International CAA Association and World Stroke Organization scientific statement on cerebral amyloid angiopathy: https://pubmed.ncbi.nlm.nih.gov/40721902/