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A 69-year-old radiologist develops an acute intense headache combined with slurring of the speech and confusion. In the emergency department, he is found to have a Glasgow coma scale of 7. An emergent CT scan of the brain reveals a well-demarcated site with bleeding in the left frontal lobe. The bleeding appears to be centered in the cortex. The patient has no other pertinent history and does not take any medications. Which of the following is most likely responsible for his findings?
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Teaching Points
- Cerebral amyloid angiopathy (CAA) is secondary to deposition of beta amyloid in the arterioles and small arteries of the brain and leptomeninges. It also is seen in Alzheimer disease.
- In cerebral amyloid angiopathy, there is intracerebral bleeding in the neocortex in a specific lobe.
- The hematoma is centered in the cerebral cortex and seen on CT scan.
- The majority of patients are over 60 years, and there is rarely blood in the cerebrospinal fluid. Patients suffering from CAA-related bleeding may not have Alzheimer disease.
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PubMed References
| [1] | Cerebral Small Vessel Disease., Li Q,Yang Y,Reis C,Tao T,Li W,Li X,Zhang JH,, Cell transplantation, 2018 Sep 25 [PubMed PMID: 30251566] |
| [2] | Journal Club: Florbetapir imaging in cerebral amyloid angiopathy-related hemorrhages., Charidimou A,Giese AK,Pasi M,van Veluw SJ,Xiong L,Fotiadis P,Marini S,Schirmer MD,Viswanathan A,, Neurology, 2018 Sep 18 [PubMed PMID: 30224502] |
