Cerebral Amyloid Angiopathy: A Common Cause of Intracerebral Hemorrhage in the Elderly - A casereport

Abstract

Cerebral amyloid angiopathy, defined as deposition of amyloid in the walls of brain vessels, is belived to be a common cause of intracerebral hemorrhage in the elderly. It differentiates from the intracerebral hemorrhage of hypertension by its specific location of bleeding. The hematoma from cerebral amyloid angiopathy, sometimes multilobar, is always located in the brain cortices and the white matter beneath them. In the previous reports, the presence of cerebral amyloid angiopathy accounts for 5-10% of non-traumatic cerebral hemorrhage. However, it has been overlooked or misdiagnosed all the time because of the lack of tissue proof. Recurrent bleeding occurs so often, as it is rare in hypertensive intracerebral hemorrhage, that we should know how to detect cerebral amyloid angiopathy and prevent rebleeding. We report a case of intracerebral hemorrhage which was misdiagnosed as tumor bleeding. The patient underwent craniotomy for evacuation of hematoma and tumor excision. There was no tumor tissue in the specimen but it showed amyloid angiopathy. We presented her clinical course and discussed the differential diagnosis of intracerebral hemorrhage. We remind all the physiatrists that cerebral amyloid angiopathy is a possible cause of intracerebral hemorrhage, and not rare.