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[A case of primary subarachnoid hemorrhage due to cerebral amyloid angiopathy]

Yohei Tateishi1, Kensaku Shibazaki, Takeshi Inoue

  • 1Department of Stroke Medicine, Kawasaki Medical School.

Rinsho Shinkeigaku = Clinical Neurology
|May 12, 2007
PubMed

Insights

Cerebral amyloid angiopathy (CAA) can cause primary subarachnoid hemorrhage (SAH) in elderly patients without hypertension. This case highlights CAA as a potential cause of SAH, even with lobar hemorrhages.

Area of Science:

  • Neurology
  • Pathology

Background:

  • Cerebral amyloid angiopathy (CAA) is a common cause of lobar intracerebral hemorrhage (ICH) in the elderly.
  • Primary subarachnoid hemorrhage (SAH) is less commonly associated with CAA.

Observation:

  • A 77-year-old man presented with right arm monoparesis and left subcortical hemorrhage, later developing SAH.
  • Cerebral angiography showed no abnormalities, but brain biopsy revealed beta-amyloid protein deposition in meningeal and cortical vessels, confirming CAA.
  • The patient experienced multiple recurrent hemorrhages, including lobar ICH and SAH, despite initial improvement.

Findings:

  • Histological examination confirmed cerebral amyloid angiopathy (CAA) with beta-amyloid deposition in cerebral and meningeal vessels.
  • The patient experienced multiple intracranial hemorrhages, including subarachnoid hemorrhage (SAH) and lobar intracerebral hemorrhage (ICH).
  • This case suggests CAA can be a cause of primary SAH, particularly in elderly individuals without hypertension.

Implications:

  • Cerebral amyloid angiopathy (CAA) should be considered in the differential diagnosis of spontaneous subarachnoid hemorrhage (SAH) in elderly patients, especially those without a history of hypertension.
  • The findings underscore the potential for CAA to cause diverse intracranial hemorrhages, including SAH and recurrent lobar ICH.
  • Further research is warranted to elucidate the mechanisms linking CAA to primary SAH and to optimize management strategies.

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