Diverging Clinical and Amyloid Positron Emission Tomography Features in Iatrogenic Cerebral Amyloid Angiopathy

Amyloid positron emission tomography (PET) features of cadaveric dural graft-associated iatrogenic cerebral amyloid angiopathy (iCAA) remain unclear. A 53-year-old man presented with forgetfulness and personality changes 41 years postgrafting. Cognitive test results revealed memory impairments; magnetic resonance imaging revealed medial temporal lobe atrophy, multiple microbleeds, and superficial siderosis; and amyloid PET revealed focal occipital uptake. Although focal amyloid accumulation associated with cognitive impairment has not been reported in patients with iCAA, decreased cerebrospinal fluid levels of amyloid-β 40 and 42, with normal levels of amyloid-β 42/40 ratio, p-tau 181, and total tau levels, suggest that iCAA may be a major underlying pathology.