Fatal Massive Intracerebral Hemorrhage Complicating Cerebral Amyloid Angiopathy

Mandybur, T. I.; Bates, Stephen R. D.

doi:10.1001/archneur.1978.00500280064014

Cited by 49 publications

(7 citation statements)

References 9 publications

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“…Hemorrhage caused by CAA involves the subcortical white matter, and frequently or without exception penetrates into the subarachnoid space 1,4 , 5,9 . Mandybur and Bates commented that because CAA affects mostly leptomeningeal and cortical vessels, the related massive intracerebral hemorrhage is usually situated close to the surface of the brain or in the subarachnoid space 10 . In the cases described in the present study, the hematomas involved the subarachnoid space including the cerebral sulci, as well as the subcortical and/or deep cerebral white matter.…”

Section: Discussionmentioning

confidence: 99%

Subcortical hematoma caused by cerebral amyloid angiopathy: Does the first evidence of hemorrhage occur in the subarachnoid space?

Takeda¹,

Yamazaki²,

Miyakawa³

et al. 2003

Neuropathology

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Six autopsy cases of subcortical hematoma caused by CAA were examined to elucidate the primary site of hemorrhage. Immunohistochemistry for amyloid beta-protein (A beta) revealed extensive CAA in the intrasulcal meningeal vessels rather than in the cerebral cortical vessels. All of the examined cases had multiple hematomas in the subarachnoid space, mainly in the cerebral sulci, as well as intracerebral hematomas. Each intracerebral hematoma was connected to the subarachnoid hematomas at the depth of cerebral sulci or through the lateral side of the cortex. There was no debris of the cerebral cortical tissue in the subarachnoid hematomas. In case 2, another solitary subarachnoid hematoma, which was not connected to any intracerebral hematoma, was seen. In all of these subarachnoid hematomas, many ruptured A beta-immunopositive arteries were observed. These ruptured arteries did not accompany any debris of the brain tissue, some of them were large in diameter (250-300 microm), and several of them were far from the cerebral cortex. Therefore, it was considered that they were not cortical arteries but meningeal arteries. Within the cerebral cortex, there were only a few ruptured arteries associated with small hemorrhages. There were no ruptured vessels within the intracerebral hematomas. There was a strong suggestion that all of the subarachnoid hematomas, including the solitary one in case 2, originated from the rupture of the meningeal arteries. The present study indicates that in some cases of subcortical hematoma caused by CAA, the primary hemorrhage occurs in the subarachnoid space, in particular the cerebral sulci, because of rupture of multiple meningeal arteries. Infarction occurs subsequently in the cortex around the hematoma, the hematoma penetrates into the brain parenchyma, and finally, a subcortical hematoma is formed.

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Section: Discussionmentioning

confidence: 99%

Subcortical hematoma caused by cerebral amyloid angiopathy: Does the first evidence of hemorrhage occur in the subarachnoid space?

Takeda¹,

Yamazaki²,

Miyakawa³

et al. 2003

Neuropathology

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“…Apart from the familial cases of CAA, 9 there have been several reports of sporadic CAA associated with intracerebral hemorrhage. 13 " 19 We report a patient with CAA and giant cell arteritis, an association not previously documented.…”

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confidence: 80%

“…13 " 19 The incidence of intracerebral hemorrhage secondary to non-familial CAA varies. Among 1,214 autopsied cases of massive cerebral hemorrhage reported by Jellinger, 21 0.2% were found to be directly related to CAA, while Hinton et al 22 showed five cases of CAA in 84 hemorrhages.…”

Section: Discussionmentioning

confidence: 99%

Cerebral amyloid angiopathy associated with giant cell arteritis: a case report.

Murphy¹,

Sima²

1985

Stroke

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A case of cerebral amyloid angiopathy associated with granulomatous arteritis is presented with description of the microscopic, immunocytochemical and ultrastructural features. The amyloid proved to be of the AL-type, with failure to show reactivity with anti-AA, anti-prealbumin and anti-albumin. Antisera against SAP and IgG (AF) did show reactivity. Hence the immunologic characteristics of this amyloid differ from those of other known conditions and may therefore represent a new form of amyloid. The role of granulomatous arteritis in this case remains speculative.

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“…The pathogenesis and pathomechanism of AA are not known, but some relationship with rheumatic disease has been suggested (14–16), namely, a specific immune disorder in the background. Rosenthal (17) found an increased serum amyloidlike substance (SAA) in the aged, especially in patients over the age of 80.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Amyloid Angiopathy in the Elderly

Tomonaga

1981

J American Geriatrics Society

146

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In this study an attempt was made to determine the relationship between cerebral amyloid angiopathy (AA) and other cerebrovascular lesions in the aged. The brains of 128 autopsy patients over 60 years of age were examined by both light and electron microscopy. The frequency of cerebral AA increased with age and was 58 percent in patients over the age of 90. The change was observed more often in women than in men. In 7 cases of severe AA, the temporal or occipital cortex was the most common site. Most cases of AA were complicated by the formation of senile plaques in the cortex. Electron microscopic examination revealed amyloid fibrils deposited in clusters in the media and adventitia of the vessels, destroying their structure. Some blood vessels on the surface of the cortex showed hyalinosis, angionecrosis, duplication of the wall, or fibrotic occlusion. AA is sometimes a cause of cerebral bleeding. Five cases of massive cerebral bleeding were found among patients aged 90 or older, including a temporal hematoma in a 92-year-old woman which was believed to be due to the marked AA noted in the temporal lobes. Small cortical infarctions were common in the temporal lobes.

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Fatal Massive Intracerebral Hemorrhage Complicating Cerebral Amyloid Angiopathy

Cited by 49 publications

References 9 publications

Subcortical hematoma caused by cerebral amyloid angiopathy: Does the first evidence of hemorrhage occur in the subarachnoid space?

Subcortical hematoma caused by cerebral amyloid angiopathy: Does the first evidence of hemorrhage occur in the subarachnoid space?

Cerebral amyloid angiopathy associated with giant cell arteritis: a case report.

Cerebral Amyloid Angiopathy in the Elderly

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