Update on Amyloid-associated Intracerebral Haemorrhage

Abstract

Cerebral congophilic or amyloid angiopathy (CAA) is a clinicopathological entity that is considered a common cause of primary non-traumatic brain haemorrhage in the elderly. CAA is frequently associated with Alzheimer’s disease (AD) and has become a primary focus of scientific inquiry. The spectrum of intracerebral haemorrhage (ICH) that may occur in CAA includes: cerebral lobar haemorrhages, deep haemorrhages, purely subarachnoid and subdural haemorrhages and cerebral microbleeds. CAA is also associated with microinfarcts, leukoencephalopathy and superficial siderosis. This brief article will provide an update on the advances in our understanding of CAA-associated ICH with a focus on the following topics: neuropathology and mechanism of CAA-related haemorrhage; epidemiology, including genetic and other possible risk factors; clinical presentation; diagnosis, including newer imaging modalities; and prospects for prevention and treatment.

The development of cerebral amyloid angiopathy in cerebral vessels. A review with illustrations based upon own investigated post mortem cases

“…Cerebral amyloid angiopathy can be clinically manifested as intracranial hemorrhage (lobar or minor hemorrhaging), ischemic stroke, leukoencephalopathy, transient ischemic attack, dementia, vasculitis or tumor [2,11,[18][19][20][21][22][23][24].…”

“…Cerebral amyloid angiopathy often appears in elderly patients though symptomatic, spontaneous lobar hemorrhaging evoking a neurological focal deficit, headaches, impairment of consciousness, seizures, cognitive impairments, dementia, depression, behavioral problems and personality changes [2,11,[18][19][20][21][22][23][24].…”

Isolated Central Sulcus Hemorrhage: A Rare Presentation Most Frequently Associated with Cerebral Amyloid Angiopathy

“…Amyloid deposition in the brain occurs within various pathologies such as Alzheimer's dementia, Creutzfeld Jacobs's disease, spongiform encephalopathies, and postradiation necrosis or can be rarely hereditary [6]. Deposition of amyloid within the cortical, subcortical, and leptomeningeal cerebral vessels results in increased fragility, hemorrhages, microaneurysms, and vascular irregularity or stenosis [7, 8]. Cerebral amyloidosis can be asymptomatic or clinically present with symptoms related to acute or chronic hemorrhage and ischemia.…”