Intracerebral hemorrhage due to cerebral amyloid angiopathy

1985 ◽  
Vol 63 (6) ◽  
pp. 965-969 ◽  
Author(s):  
Norbert Roosen ◽  
Jean-Jacques Martin ◽  
Christian De La Porte ◽  
Michel Van Vyve
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Clinicopathological Features ◽  
Amyloid Angiopathy ◽  
Correct Treatment ◽  
Content Type ◽  
Cerebral Amyloid ◽  
Occipital Lobes ◽  
The Relationship ◽  
Fine Print

✓ The case is presented of a 59-year-old man with cerebral amyloid angiopathy and three consecutive hemorrhages in the occipital lobes. The clinicopathological features and the relationship to Alzheimer's dementia are discussed. The correct treatment of intracerebral hemorrhage related to cerebral amyloid angiopathy is a matter of controversy.

Lobar intracerebral hemorrhage

1992 ◽  
Vol 76 (2) ◽  
pp. 231-238 ◽  
Author(s):  
Susumu Wakai ◽  
Nahomi Kumakura ◽  
Masakatsu Nagai
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Vascular Malformation ◽  
Cavernous Malformation ◽  
Ct Scans ◽  
Amyloid Angiopathy ◽  
Content Type ◽  
Negative Angiography ◽  
Cerebral Amyloid ◽  
Fine Print

✓ The authors operated consecutively on 50 patients with lobar intracerebral hemorrhage during a prospectively designed study period from January, 1986, to March, 1990. They investigated the correlations between the underlying causes and the clinicoradiographic features in 29 patients who showed no angiographic vascular abnormalities, in order to elucidate the operative indication for such cases. Patients with ruptured saccular aneurysm or trauma were not included in this study. There were 15 males and 14 females, ranging in age from 7 to 76 years (mean 52.4 years). Histological diagnoses of the surgical specimens were as follows: vascular malformation in nine cases (arteriovenous malformation (AVM) in six and cavernous malformation in three), microaneurysm in 11, cerebral amyloid angiopathy in six, and brain tumor in two; in the remaining case the cause was not verified histologically. The underlying cause was determined in 96.5% of cases. The mean patient age was lowest in the cavernous malformation group (27.0 years), followed by the AVM (45.8 years), microaneurysm (59.8 years), and cerebral amyloid angiopathy (70.0 years) groups. Four patients with vascular malformation (three AVM's and one cavernous malformation) had previous episodes of bleeding at the same site, whereas none of those with microaneurysms or cerebral amyloid angiopathy had such episodes. On computerized tomography (CT) scans, the round to oval hematoma was related to the presence of an AVM or cavernous malformation in contrast to microaneurysms and cerebral amyloid angiopathy. Upon infusion of contrast material, variable enhancement was seen in five (two AVM's and three cavernous malformations) of the nine vascular malformations while no enhancement was noted in any patient with microaneurysm or cerebral amyloid angiopathy at the acute stage. Subarachnoid extension of the hematoma was associated with cerebral amyloid angiopathy significantly more frequently than with AVM's (p < 0.05) and microaneurysms (p < 0.01). The results suggest that clinicoradiographic pictures in cases with negative angiography are quite different among the three major pathological categories; namely, vascular malformation (AVM and cavernous malformation), microaneurysm, and cerebral amyloid angiopathy. It is suggested that the underlying etiology of a given lobar intracerebral hemorrhage with negative angiography may be predicted by a combination of patient age, history of previous bleeding at the same site, hematoma shape, and subarachnoid extension of the hematoma on CT scans. Based upon these findings, the authors discuss operative indications for such cases.

Abstract WMP100: Topographical Distribution of Lacunes in Cerebral Amyloid Angiopathy and Deep Hypertensive Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Marco Pasi ◽  
Gregoire Boulouis ◽  
Panagiotis Fotiadis ◽  
Andreas Charidimou ◽  
Eitan Auriel ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Brain Regions ◽  
Amyloid Angiopathy ◽  
Topographical Distribution ◽  
Close Relationship ◽  
Cerebral Amyloid ◽  
Highly Correlated ◽  
Hypertensive Intracerebral Hemorrhage ◽  
The Relationship

Background/Aims: To evaluate whether the burden of lacunes located at deep and lobar brain regions, would differ between intracerebral hemorrhage patients (ICH) with cerebral amyloid angiopathy (CAA) vs patients with strictly deep cerebral microbleeds (CMB) and ICH (Deep HTN-ICH). Methods: We defined lobar and deep lacunes similar to the topographic distribution used for ICH and microbleeds. We then compared their distribution between CAA and Deep HTN-ICH patients. The independent associations of lacune location (lobar vs deep) with diagnosis of CAA-ICH and Deep HTN-ICH were evaluated using multivariable models. The relationship between lobar and deep lacunes and WMH volume was evaluated using partial correlation analyses adjusting for age and by means of a validated visual scale. Results: In our cohort of 316 ICH patients, lobar lacunes were more commonly present in CAA (20.4% vs 5.7% in Deep HTN-ICH, p<0.001; see figure) while deep lacunes more frequent in Deep HTN-ICH patients (15.2% vs 2.1%, p<0.001; see figure). After correction for demographics, clinical and neuroimaging markers of SVD, lobar lacunes were associated with CAA diagnosis (p=0.023), while deep lacunes with Deep HTN-ICH (p<0.001). Lobar lacunes in 80% of the cases were at least in contact with WMH and after adjustment for age they were highly correlated to WMH volume ( r=0.52, p<0.001). Conclusions: Lobar lacunes are associated with CAA whereas deep lacunes are more frequent in patients with Strictly deep CMBs and ICH, they can thus be clinically useful in the appropriate context. Lobar lacunes seem to have a close relationship with WMH suggesting a possible common origin.

Cerebral amyloid angiopathy presenting as multiple intracranial lesions on magnetic resonance imaging

1991 ◽  
Vol 75 (3) ◽  
pp. 458-460 ◽  
Author(s):  
Deepak Awasthi ◽  
Rand M. Voorhies ◽  
John Eick ◽  
William T. Mitchell
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Amyloid Angiopathy ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Normotensive Patient ◽  
Content Type ◽  
Imaging Characteristics ◽  
Cerebral Amyloid

✓ Cerebral amyloid angiopathy is recognized as an important cause of spontaneous intracerebral hemorrhage in the elderly normotensive patient. Magnetic resonance (MR) imaging characteristics of this disease entity are rarely mentioned in the literature. The MR imaging findings of an elderly normotensive patient presenting with an acute spontaneous intracerebral hemorrhage secondary to amyloid angiopathy are reported and a brief review of amyloidosis is presented.

Cerebral amyloid angiopathy with multiple intracerebral hemorrhages

1982 ◽  
Vol 57 (2) ◽  
pp. 286-289 ◽  
Author(s):  
Kenneth L. Tyler ◽  
Charles E. Poletti ◽  
Roberto C. Heros
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Neurological Disorders ◽  
Brain Parenchyma ◽  
Amyloid Angiopathy ◽  
Content Type ◽  
Intracerebral Hemorrhages ◽  
Cerebral Amyloid ◽  
Unclear Etiology ◽  
Adjacent Brain

✓ Cerebral amyloid angiopathy (CAA) has been associated with atypical dementia and a variety of other neurological disorders. Intracerebral hemorrhage is the most striking manifestation of CAA. A 63-year-old patient is described who sustained four intracerebral hemorrhages although he had no predisposing factors other than CAA. The neurological and pathological features of CAA are reviewed, with particular emphasis on the problem of CAA-associated intracerebral hemorrhage. On the basis of the experience with this case, it is recommended that adjacent brain parenchyma be biopsied in all patients undergoing evacuation of intracerebral hematomas of unclear etiology.

Clinical and neuropathologic analysis of intracerebral hemorrhage in patients with cerebral amyloid angiopathy

2019 ◽  
Vol 176 ◽  
pp. 110-115
Author(s):  
Taro Yanagawa ◽  
Masaki Takao ◽  
Masami Yasuda ◽  
Tomoya Kamide ◽  
Hiroki Sato ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Amyloid Angiopathy ◽  
Cerebral Amyloid

Abstract 36: The Boston Criteria V2.0 for Cerebral Amyloid Angiopathy: Updated Criteria and Multicenter MRI-Neuropathology Validation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Andreas Charidimou ◽  
Gregoire Boulouis ◽  
Matthew Frosch ◽  
Jean-Claude Baron ◽  
Marco Pasi ◽  
...  
Keyword(s):  
White Matter ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Cerebral Amyloid Angiopathy ◽  
Brain Mri ◽  
Amyloid Angiopathy ◽  
Perivascular Spaces ◽  
Validation Sample ◽  
Temporal Validation ◽  
Cerebral Amyloid

Introduction: The Boston criteria are used worldwide for in vivo diagnosis of cerebral amyloid angiopathy (CAA). Given substantial advances in CAA research, we aimed to update the Boston criteria and externally validate their diagnostic accuracy across the spectrum of CAA-related presentations and across international sites. Methods: As part of an International CAA Association multicenter study, we identified patients age 50 or older with potential CAA-related clinical presentations (spontaneous intracerebral hemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathologic assessment for the diagnosis of CAA. We derived Boston criteria v2.0 by selecting MRI features to optimize diagnostic specificity and sensitivity in a pre-specified derivation sample (Boston cases 1994 to 2012, n=159), then externally validated in pre-specified temporal (Boston cases 2012-2018, n=59) and geographical (non-Boston cases 2004-2018; n=123) validation samples and compared their diagnostic accuracy to the currently used modified Boston criteria. Results: Based on exploratory analyses in the derivation sample, we derived provisional criteria for probable CAA requiring presence of at least 2 strictly lobar hemorrhagic lesions (intracerebral hemorrhage, cerebral microbleed, or cortical superficial siderosis focus) or at least 1 strictly lobar hemorrhagic lesion and 1 white matter characteristic (severe degree of visible perivascular spaces in centrum semiovale or white matter hyperintensities multispot pattern). Sensitivity/specificity of the criteria were 74.8/84.6% in the derivation sample, 92.5/89.5% in the temporal validation sample, 80.2/81.5% in the geographic validation sample, and 74.5/95.0% in cases across all samples with autopsy as the diagnostic gold standard. The v2.0 criteria for probable CAA had superior accuracy to the currently modified Boston criteria (p<0.005) in the autopsied cases. Conclusion: The Boston criteria v.2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their high specificity. Validation of the criteria across independent patient settings firmly supports their adoption into clinical practice and research.

Subacute Cognitive Decline in an 86-Year-Old Woman With Prior Lobar Intracerebral Hemorrhage

2021 ◽  
pp. 192-194
Author(s):  
Stephen W. English ◽  
James P. Klaas
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cognitive Decline ◽  
Temporal Lobe ◽  
Cerebral Amyloid Angiopathy ◽  
Mass Effect ◽  
Amyloid Angiopathy ◽  
Left Temporal Lobe ◽  
Epileptiform Discharges ◽  
Cerebral Amyloid ◽  
T2 Hyperintensity

An 86-year-old woman with a history of hypertension, hyperlipidemia, coronary artery disease, and hypothyroidism sought care for subacute, progressive cognitive decline. Five months earlier, she was hospitalized for a small, left temporal, lobar, intracerebral hemorrhage with associated receptive aphasia. Over the next several months, she had a precipitous cognitive decline. She was prescribed memantine by her primary physician because of concern for dementia. One month before seeking care, she was found unconscious in her bathroom, which was believed to be an unwitnessed seizure. Brain magnetic resonance imaging 1 month before the current evaluation showed a prior, small, left temporal hemorrhage and diffuse lobar microhemorrhages on gradient echo imaging, focal leptomeningeal gadolinium enhancement in the left temporal lobe, and multifocal T2 hyperintensity with mass effect, maximal in the left temporal lobe. Electroencephalography showed multifocal, independent epileptiform discharges. She underwent open biopsy of the left temporal lobe, which indicated focal granulomatous inflammation causing vascular destruction, with β‎-amyloid plaques within the cortical and leptomeningeal vessels. The findings were consistent with a diagnosis of amyloid-β‎-related angiitis in the setting of severe cerebral amyloid angiopathy. Because of concern for subclinical seizures and epileptiform discharges on electroencephalography, the patient was started on levetiracetam without substantial change in her mental status. After the biopsy findings demonstrated inflammatory changes consistent with amyloid-β‎-related angiitis, she was started on intravenous methylprednisolone, followed by transition to prednisone. After 6 months of treatment, she had significant clinical and radiographic improvement. Follow-up magnetic resonance imaging at that time showed interval improvement in the T2 hyperintensity and mass effect in the left temporal lobe. She was again independent with her activities of daily living, and memantine was discontinued. Cerebral amyloid angiopathy encompasses a heterogeneous group of diseases characterized by amyloid-β‎ peptide deposition. The most common clinical manifestation of cerebral amyloid angiopathy is lobar intracerebral hemorrhage, which can be multifocal and recurrent but can also result in cerebral ischemia and ischemic leukoencephalopathy.

scholarly journals Risk of Intracerebral Hemorrhage and Mortality After Convexity Subarachnoid Hemorrhage in Cerebral Amyloid Angiopathy

Stroke ◽  
2019 ◽  
Vol 50 (9) ◽  
pp. 2562-2564 ◽  
Author(s):  
Lionel Calviere ◽  
Alain Viguier ◽  
Sofia Patsoura ◽  
Vanessa Rousseau ◽  
Jean-François Albucher ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Amyloid Angiopathy ◽  
Cerebral Amyloid
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