Recurrent Focal Neurological Symptoms and Cortical Siderosis

A 90-year-old male presented with 2 episodes of reversible left-hand weakness, each lasting approximately 15 minutes. He had a previous history of multiple episodes of stereotyped, reversible right-sided paresthesias followed by hemiparesis and dysarthria lasting 1 minute in duration, interpreted as transient ischemic attacks (TIAs) and treated with clopidogrel. The patient was in no acute distress at the time of presentation and was without any cognitive deficits. Subsequent brain magnetic resonance imaging revealed subarachnoid hemorrhage on both parietal convexities (Figure 1A, arrows). Dark signal on gradient echo sequences with gyriform distribution involving the frontoparietal region was observed (white arrowheads), consistent with cortical siderosis (Figure 1B). Positron emission tomography scan with 18florbetapir demonstrates diffuse cortical radiotracer uptake (Figure 1C, black arrowheads). In addition to these radiographic findings, further subsequent evaluation revealed elevated cerebral spinal fluid β-amyloid