Possible Iatrogenic Cerebral Amyloid Angiopathy Presenting with Recurrent Lobar Hemorrhages: A Case Report

Iatrogenic cerebral amyloid angiopathy is a rare condition thought to result from prion-like transmission of amyloid-β, typically after childhood neurosurgery or exposure to cadaveric dura mater, with a latency period of several decades. We report the case of a 60-year-old woman who underwent a right frontal craniotomy for traumatic head injury at the age of 12 years, although it was unknown whether cadaveric dura mater was used. Approximately 48 years later, she developed a right frontal lobar hemorrhage near the prior craniotomy site and experienced more than 15 recurrent intracerebral hemorrhages, predominantly involving lobar regions over 3 months. Histopathology of hematoma-adjacent tissue revealed marked amyloid-β deposition without significant tau pathology or inflammation, and apolipoprotein E genotype was ε3/ε3. Based on clinical, pathological, and epidemiological findings, the case met the Queen Square criteria for possible iatrogenic cerebral amyloid angiopathy. The exceptionally long latency and unusually frequent recurrent hemorrhages were the most striking features of this case. Iatrogenic cerebral amyloid angiopathy should be considered even in older adults, as remote neurosurgical history remains an important diagnostic clue. Because amyloid-β is resistant to conventional sterilization, special attention to the sterilization of surgical instruments is also warranted when patients with a remote neurosurgical history undergo further neurosurgery.