Intracerebral hemorrhage secondary to cerebral amyloid angiopathy.

“…Nine (36%) studies [15,17,19,21,24,25,27,30,31] distinguished first-ever from recurrent ICH. A pre-ICH history of hypertension or dementia were described in 19 (76%) [12,14–19,21–29,31–33] and 14 (56%) studies [11,12,14,15,17,19,22,25,27–31] respectively.…”

Section: Resultsmentioning

confidence: 99%

Imaging features of intracerebral hemorrhage with cerebral amyloid angiopathy: Systematic review and meta-analysis

et al. 2017

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BackgroundWe sought to summarize Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) features of intracerebral hemorrhage (ICH) associated with cerebral amyloid angiopathy (CAA) in published observational radio-pathological studies.MethodsIn November 2016, two authors searched OVID Medline (1946-), Embase (1974-) and relevant bibliographies for studies of imaging features of lobar or cerebellar ICH with pathologically proven CAA (“CAA-associated ICH”). Two authors assessed studies’ diagnostic test accuracy methodology and independently extracted data.ResultsWe identified 22 studies (21 cases series and one cross-sectional study with controls) of CT features in 297 adults, two cross-sectional studies of MRI features in 81 adults and one study which reported both CT and MRI features in 22 adults. Methods of CAA assessment varied, and rating of imaging features was not masked to pathology. The most frequently reported CT features of CAA-associated ICH in 21 case series were: subarachnoid extension (pooled proportion 82%, 95% CI 69–93%, I2 = 51%, 12 studies) and an irregular ICH border (64%, 95% CI 32–91%, I2 = 85%, five studies). CAA-associated ICH was more likely to be multiple on CT than non-CAA ICH in one cross-sectional study (CAA-associated ICH 7/41 vs. non-CAA ICH 0/42; χ2 = 7.8, p = 0.005). Superficial siderosis on MRI was present in 52% of CAA-associated ICH (95% CI 39–65%, I2 = 35%, 3 studies).ConclusionsSubarachnoid extension and an irregular ICH border are common imaging features of CAA-associated ICH, but methodologically rigorous diagnostic test accuracy studies are required to determine the sensitivity and specificity of these features.

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“…Cerebral amyloid angiopathy (CAA) is one cause of spontaneous ICH that occurs mainly in the cortical and subcortical areas of the cerebrum in elderly people, but hypertensive microangiopathy‐related ICH can happen in the putamen, thalamus, midbrain, pons, and cerebellum 1–6 . CAA, which is characterized by pathological deposition of β‐amyloid protein in the media and adventitia of small and medium‐sized vessels of the cerebral cortex, subcortex, and leptomeninges, is mostly sporadic and rarely hereditary 1,4 .…”

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confidence: 99%

“…The Boston Criteria for diagnosis of clinically suspected CAA includes possible CAA (only 1 cortical ICH), probable CAA (>1 cortical ICH), probable CAA with pathologic specimen proof, and definite CAA (with postmortem examination) 1 . If brain CT of a normotensive elderly patient reveals spontaneous cortical–subcortical ICH that may be associated with subarachnoid, subdural, or intraventricular hemorrhage, differential diagnoses should include trauma, neoplasm, CAA, coagulopathy, rupture of aneurysm, and vasculitis 1,3,4 . CAA‐related ICH occurs in an older age group than hypertension‐related ICH and rarely in basal ganglia 6 .…”

mentioning

confidence: 99%