Transient Functional Neurological Episodes Associated with Cerebral Amyloid Angiopathy

A 76 year old man with a background of chronic kidney disease (CKD) and cerebral amyloid angiopathy (CAA) presented with a 3 day history of stereotyped, self-resolving episodes of left sided paraesthesia and weakness. He did not have any loss of consciousness, abnormal movements, speech or visual disturbance. His neurological examination was entirely normal. Blood tests were unremarkable and his renal function was at baseline. Magnetic resonance imaging (MRI) identified a new area of superficial siderosis and an acute convexity sub-arachnoid haemorrhage (cSAH). This presentation is classical for a CAA-associated transient functional neurological episode (TFNE). Stroke clinicians should be aware of this important stroke mimic, as antiplatelet medication is likely to worsen the underlying pathology.