Clinical Neuropathological Analysis of 10 Cases of Cerebral Amyloid Angiopathy-Related Cerebral Lobar Hemorrhage

Abstract

ObjectiveThe clinical and pathological characteristics of 10 cases of cerebral amyloid angiopathy (CAA)-related cerebral lobar hemorrhage (CLH) that was diagnosed at autopsy were investigated to facilitate the diagnosis of this condition.MethodsThe clinical characteristics of 10 cases of CAA-related CLH were retrospectively reviewed, and a neuropathological examination was performed on autopsy samples.ResultsThe 10 cases included two with a single lobar hemorrhage and eight with multifocal lobar hemorrhages. In all of the cases, the hemorrhage bled into the subarachnoid space. Pathological examinations of the 10 cases revealed microaneurysms in two, double barrel-like changes in four, multifocal arteriolar clusters in five, obliterative onion skin-like intimal changes in four, fibrinoid necrosis of the vessels in seven, neurofibrillary tangles in eight, and senile plaques in five cases.ConclusionCAA-related CLHs were located primarily in the parietal, temporal, and occipital lobes. These hemorrhages normally consisted of multiple repeated CLHs that frequently bled into the subarachnoid space. CAA-associated microvascular lesions may be the pathological factor underlying CLH.

Florbetapir Regional Distribution in Cerebral Amyloid Angiopathy and Alzheimer’s Disease: A PET Study

“…Based on pathological studies demonstrating that the occipital lobe is the most severely affected by CAA [14,15], it had been hypothesized that amyloid tracer retention would predominantly be increased in the occipital region. Only two amyloid PET studies, using PiB, have explored the burden and distribution of amyloid in CAA patients compared to patients with probable AD.…”

Cerebral Arterial Stenosis in Patients with Spontaneous Intracerebral Hemorrhage

“…Lobar and non-lobar ICH are presumably caused by different types of microangiopathy, and risk factors for ICH may vary according to the location of ICH 12) . Regarding the location of ICH, lobar ICH frequently recurs as lobar ICH suggesting the participation of cerebral amyloid angiopathy as a main pathogenesis, but ganglionic ICH may have a chance of recurrence both as infarction and ganglionic ICH, suggesting the participation of intracranial atherosclerosis 7 , 14 , 19) . However, the presence of cerebral arterial stenosis did not differ between patients with lobar and non-lobar ICH in the present study, and further larger sample size study is required to elucidate the association between cerebral arterial stenosis and location of ICH.…”