Cerebral amyloid angiopathy-related infarcts imitating high-grade differentiation of a benign meningioma

Meningiomas are divided, by the WHO, into three groups: benign (grade I), atypical (grade II) and malignant (grade III). Although some overlapping features can occur, atypical meningiomas are more likely to exhibit heterogeneous density or intensity, heterogeneous contrast enhancement and relatively large perifocal oedema on CT scan and MRI.1 Meningiomas typically receive their blood supply from dural arteries, although larger meningiomas can also have a blood supply from leptomeningeal or parenchymal branches. Cerebral amyloid angiopathy (CAA) results from β-amyloid deposition in the walls of leptomeningeal and cortical arteries.2 It usually causes lobar intracerebral haemorrhage and often occurs in association with Alzheimer's disease.

Rarely, CAA has been documented to be associated with inflammatory changes, sometimes thought to be co-existent primary central nervous system vasculitis or giant cell arteritis, although most literature has focused on probable inflammatory changes secondary to β-amyloid deposition, sometimes described as amyloid β-related angiitis.3–6 We could not find any specific association of CAA with Wegener's granulomatosis in the literature.