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Bacterial meningitis — SCE Neurology MCQ

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HardCNS InfectionsBacterial meningitisSCE Neurology

A 72-year-old develops rapidly progressive cognitive decline, seizures and an asymmetric vasogenic white-matter lesion with numerous lobar microbleeds. Biopsy shows vascular amyloid plus inflammatory cells. Which histological finding specifically upgrades CAA-related inflammation to amyloid-beta-related angiitis?

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Correct answer: D — Inflammation infiltrating and damaging the amyloid-laden vessel wall

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · B = shown as D · C = shown as E

A describes CAA-related inflammation, where inflammation is predominantly perivascular. B is correct: ABRA requires true angiitis, with inflammatory infiltration and damage of the amyloid-bearing vessel wall. C is non-inflammatory CAA. D suggests another granulomatous meningitis. E may occur in non-amyloid vasculitis but does not establish ABRA. This distinction is pathological; the clinical and MRI phenotypes overlap, and both may respond to corticosteroid-based immunotherapy.

Reference: Amyloid-beta-related angiitis: a treatable rapidly progressive dementia: https://pn.bmj.com/content/22/3/228