Cerebral amyloid angiopathy hemorrhage

Fig. 13.5. T2 -weighted gradient echo images in a patient with biopsy proven cerebral amyloid angiopathy (CAA). Extensive low signal abnormality is noted on the brain surfaces and in the parenchyma indicating the previous hemorrhages. Periventricular high intensity lesions, a common finding in CAA is also noted...

Greenberg SM, Briggs ME, Hyman BT et al (1996b) Apoli-poprotein E e4 is associated with the presence and earlier onset of hemorrhage in cerebral amyloid angiopathy. Stroke 27 1333-1337... 

Greenberg SM, O Donnell HC, Schaefer PW, Kraft E (1999) MRI detection of new hemorrhages potential marker of progression in cerebral amyloid angiopathy. Neurology 53 1135-1138... 

Itoh Y, Yamada M, Hayakawa M, Otomo E, Miyatake T (1993) Cerebral amyloid angiopathy a significant cause of cerebellar as well as lobar cerebral hemorrhage in the elderly. J Neurol Sci 116 135-141... 

M8. McCarron, M. O., Nicoll, J. A. R., Stewart, J., Ironside, J. W., Mann, D. M. A., etal., Absence of cystatin C mutation in sporadic cerebral amyloid angiopathy-related hemorrhage. Neurology 54, 242-244 (2000). 

Primary intracerebral hemorrhage is more common than subarachnoid hemorrhage, and its incidence increases with age (see Fig. 1.1). It is more frequent in Southeast Asian, Japanese and Chinese populations than in whites. The most common causes are intracranial small vessel disease, which is associated with hypertension, cerebral amyloid angiopathy and intracranial vascular malformations (Sutherland and Auer 2006). Rarer causes include saccular aneurysms, hemostatic defects, particularly those induced by anticoagulation or therapeutic thrombolysis, antiplatelet drugs, infective endocarditis, cerebral vasculitis and recreational drug use (Neiman et al. 2000 O Connor et al. 2005). 

The site of primary intracerebral hemorrhage provides information as to the cause hypertensive hemorrhages (Fig. 7.1a) tend to occur in the basal ganglia, thalamus, and pons, while lobar hemorrhages are more often caused by cerebral amyloid angiopathy, vascular malformations and hemostatic failure (Dickinson 2001 Smith and Eichler 2006 Sutherland and Auer 2006) (Table 7.1) (Fig. 7.1b). Multiple hemorrhages suggest certain specific causes ... 

Cerebral microbleeds are seen frequently in patients with primary intracerebral hemorrhage, less commonly in patients with ischemic stroke and rarely in healthy controls (Cordonnier et al. 2007). Risk factors for cerebral microbleeds include hypertension, increasing age, diabetes, cerebral amyloid angiopathy and, less commonly, cerebral autosomal dominant arteriopathy with silent infarcts and leukoaraiosis (CADASIL) (Cordoimier et al. 2007). It is unclear whether previous use of antiplatelet agents or anticoagulants is a risk factor for cerebral microbleeds. 

Smith EE, Eichler F (2006). Cerebral amyloid angiopathy and lobar intracerebral hemorrhage. Archives of Neurology 63 148-151... 

Izumihara A, Ishihara T, Iwamoto N et al. (1999). Postoperative outcome of 37 patients with lobar intracerebral hemorrhage related to cerebral amyloid angiopathy. Stroke 30 29-33... 

Fryer JD, Taylor JW, DeMattos RB, Bales KR, Paul SM, Parsadanian M, Holtzman DM (2003) ApoUpoprotein E markedly fadlitates age-dependent cerebral amyloid angiopathy and spontaneous hemorrhage in amyloid precursor protein transgenic mice. J Neurosci 23 7889-7896... 

Fig. 14. Transmission in two families of the allele causing hereditary cystatin C amyloid angiopathy, HCCAA (also called hereditary cerebral hemorrhage with amyloidosis, HCHWA).

J2. Jensson, O., Gudmundsson, G., Arnason, A., Blondal, H., Petursdottir, I., et al., Hereditary cystatin C (y -trace) amyloid angiopathy of the CNS causing cerebral hemorrhage. Acta Neurol. Scand. 76, 102-114 (1987). 

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