Cerebral amyloid angiopathy manifesting as recurrent intracerebral hemorrhage

Over a period of eight years, a normotensive woman experienced eight strokelike episodes. Computed tomographic (CT) scans obtained during each of the last seven episodes demonstrated intracerebral lobar hemorrhage. Cerebral angiography and contrast-enhanced CT scans demonstrated no underlying abnormality. Our patient had recurrent intracerebral hemorrhage (ICH) with no predisposing factors or dementia. The clinical diagnosis was primary cerebral amyloid angiopathy (CAA). Brain biopsy specimens demonstrated light microscopic and ultrastructural evidence of amyloid in cerebral arterioles. We believe that the combined clinical, CT, and ultrastructural changes in this case are unique. Recurrent ICH visualized by CT scanning has diagnostic value in CAA.