Fatal massive intracerebral hemorrhage complicating cerebral amyloid angiopathy

A 58-year-old normotensive woman died 24 hours after a stroke. Two months earlier, she had a transient neurological episode consistent with cerebrovascular insufficiency. Necropsy demonstrated a massive recent hemorrhage in the right occipital lobe associated with severe cerebral amyloid angiopathy (CAA). The cerebral cortex showed interstitial and perivascular neuritic plaques but no Alzheimer's tangles. There was no family history of CAA. A review of the literature indicated that only ten cases of such hemorrhage caused by nonfamilial CAA have been reported. Massive intracerebral hemorrhage seems to be more common in patients with familial Icelandic forms of CAA.