Cerebral amyloid angiopathy-associated lobar intracerebral haemorrhage

Case contributed by Dr Mark Rodrigues


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Patient Data

Age: 80 years
Gender: Female

Images degraded by patient movement.

Acute right occipital haematoma involving the cortex and subcortical white matter. Localised subarachnoid haemorrhage. No sub/extradural or intraventricular haemorrhage.

Moderate periventricular low attenuation in keeping with small vessel disease. Mild generalised cerebral volume loss

Images degraded by patient movement.

Signal drop out in the right occpital lobe on GRE consistent with a haematoma. Localised cortical superficial siderosis. No definite microbleeds and no other macrohaemorrages.

Moderate white matter hyperintensities.

Case Discussion

Right occipital lobar haemorrhage with involvement of the cortex, extension into the subarachnoid space. Background changes of cortical superficial siderosis, and small vessel disease (white matter hyperintensities) and mild atrophy.

Lobar intracerebral haemorrhage is frequently attributed to small vessel diseases (cerebral amyloid angiopathy or arteriolosclerosis). Differentiating lobar haemorrhage due to cerebral amyloid angiopathy and arteriolosclerosis is important due to differences in recurrent ICH and post-stroke dementia risk (higher with CAA-associated ICH).

The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy uses CT features (presence of subarachnoid haemorrhage, finger-like projections arising from the ICH) and APOE e4 genotype (if available) to classify a patient as high, intermediate or low risk of CAA-associated ICH. The initial CT shows subarachnoid haemorrhage but no finger-like projections from the haematoma. The patient possessed at least one APOE e4 allele. Therefore they are high risk for CAA-associated ICH on the Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy.

This patient has a single lobar macrohaemorrhage and focal cortical superficial siderosis and so is probable CAA on the modified Boston criteria.


PATHOLOGY: Post mortem showed a right occipital lobar haematoma with extensive cerebral amyloid angiopathy and vasculopathic changes. Mild small vessel disease. Alzheimer's-type pathology (Braak and Braak stage 4).

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Case information

rID: 58377
Case created: 14th Feb 2018
Last edited: 15th Feb 2018
Inclusion in quiz mode: Included
Institution: University of Edinburgh

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