Amyloid angiopathy causing widespread miliary haemorrhages within the brain evident on MRI

Area of Science:

• Neurology
• Neuroradiology
• Pathology

Background:

• Cerebral amyloid angiopathy (CAA) is a common cause of non-traumatic intracranial hemorrhage, particularly in the elderly.
• CAA is characterized by the deposition of amyloid-beta protein in the walls of cerebral arteries, leading to vessel weakening and rupture.
• The typical presentation of intracranial hemorrhage in CAA involves lobar hematomas.

Observation:

• A case study of a 70-year-old woman diagnosed with cerebral amyloid angiopathy (CAA) is presented.
• Magnetic Resonance Imaging (MRI) revealed widespread miliary (small, seed-like) foci of hemorrhage in both the cerebrum and cerebellum.
• Additional linear lesions were observed in the cerebral cortex, and patchy lesions were noted in the white matter.

Findings:

• The observed pattern of hemorrhage in this patient with CAA was atypical.
• The widespread miliary, linear, and patchy hemorrhages contrast with the more commonly reported lobar hematomas associated with CAA.
• This presentation suggests a broader spectrum of imaging findings in CAA-related intracranial hemorrhage.

Implications:

• The findings suggest that CAA may manifest with diverse patterns of intracranial hemorrhage beyond the typical lobar presentation.
• Radiologists and clinicians should consider CAA in the differential diagnosis of various hemorrhage patterns, even if not classically lobar.
• Further research is warranted to understand the underlying mechanisms and clinical significance of these atypical CAA hemorrhage patterns.