Cerebral arteriopathy with @entity1188 and XXXX in acromegalic @entity1 with severe @entity10 .

@entity1 @entity308 @entity101 @entity6 @entity2299 @entity75 @entity73 @entity66 @entity442 @entity2124 @entity2012 @entity7363 @entity1188 @entity977 @entity74 @entity1296 @entity62 @entity1943 @entity10
UNASSIGNED: A 68-year-old female @entity1 was admitted in our clinic with severe frontal @entity10 , @entity1296 , @entity308 and @entity73 in the context of a previously diagnosed @entity2012 . She also had @entity101 , @entity2299 , @entity6 . @entity2012 was caused by a @entity2124 ( @entity2124 ) secreting-pituitary macroadenoma, so a transsphenoidal surgery was performed. The postoperative magnetic resonance imaging (MRI) scan revealed a 20  22  25 mm pituitary mass remnant and medical therapy with @entity1943 analogues (SSAs) was started. After nine months of treatment with SSAs, she continued having severe @entity10 , the blood pressure was well controlled, but @entity2124 secretion was only partially controlled with @entity442 ( @entity442 ) level still above the normal value. The MRI scan showed the same @entity977 remnant with supra- and parasellar right extension and also multiple fronto-temporo-parietal @entity75 that could suggest in the clinical context cerebral @entity74 with @entity1188 and @entity62 (CADASIL). According to a pregenetic screening tool, the Pescini Scale, the @entity1 had a 19 points score, which is highly suggestive for CADASIL, an @entity74 due to mutations of the @entity7363 gene at the chromosome locus 19p13. In the absence of genetic testing, an alternate way to prove small vessels disease, the skin biopsy, was performed. Electron microscopy showed granular osmiophilic material (GOM) surrounding the vascular smooth muscle cells on that are pathognomonic for the disease. Our report underscores the importance of repeated investigations even in @entity1 with apparently obvious explanations of their condition since they may have @entity66 with the same presenting clinical signs.
