[Multiple hemorrhagic cerebral amyloid angiopathy associated with leukoencephalopathy]

The authors present a case of cerebral amyloid angiopathy (CAA) which caused multiple recurrent subcortical hemorrhages and leukoencephalopathy similar to Binswanger's disease. CT scan revealed bilateral hypodensity of the hemispheric white matter in addition to multiple subcortical hemorrhages. The difference between white and gray matter densities was 14 approximately 15 HU. T2-weighted MRI showed the hemispheric white matter as high intensity. These findings on CT and MRI are compatible with those observed in leukoencephalopathy like Binswanger's disease. A biopsy of the cortex was performed and histological examination revealed amyloid deposition in the arterial wall. In addition to amyloid deposition, obliterative intimal proliferation and hyaline degeneration of the vessel were observed. It is thought that the occlusive vascular change due to CAA may induce chronic hypoperfusion of the hemispheric white matter and consequently the leukoencephalopathy may develop. In the aged population, CAA is noteworthy as a cause of both hemorrhagic and ischemic lesions, because the incidence of CAA is increasing with age.