BACKGROUND: Cerebral amyloid angiopathy is a well-known disease that is predominantly recognized in elderly people and repeatedly causes large subcortical hemorrhages. These hemorrhages may be derived from vessel wall weakness because of Abeta depositions in the wall of the cortical and leptomeningeal arteries. Although vessel ruptures in CAA have been thought to occur in cortical arteries, it was recently demonstrated that the primary hemorrhage occurs in the subarachnoid space, particularly the cerebral sulci, as a result of multiple ruptures of meningeal arteries in some cases of subcortical hematoma caused by CAA. CASE DESCRIPTION: Case patient 1 was a 74-year-old woman who presented with epileptic seizure. A restricted SAH in the right frontal lobe was observed on MRI. Thirty-three days later, left hemiparesis occurred suddenly and a huge subcortical hematoma was observed in the right frontal lobe on CT. The hematoma was removed, and the patient was pathologically diagnosed with amyloid angiopathy. Case patient 2 was a 73-year-old man who presented with epileptic seizure. A restricted SAH in the right frontal lobe was observed on MRI. Twenty days later, left hemiparesis occurred suddenly and a huge subcortical hematoma was observed in the right frontoparietal area on CT. Hematoma removal was performed on both patients, and they were diagnosed pathologically with amyloid angiopathy. CONCLUSIONS: We report on the cases of 2 patients with CAA who presented with epileptic seizure and were found to have a restricted subarachnoid hematoma in the cerebral sulcus on MRI before their subcortical hemorrhages occurred. Both cases were diagnosed pathologically. This demonstrated that vessel ruptures in CAA can occur in the subarachnoid space, particularly the cerebral sulci, as a result of ruptures of meningeal arteries. A restricted SAH on CT/MRI could be a warning sign of a huge subcortical hemorrhage in CAA.
BACKGROUND:Cerebral amyloid angiopathy is a well-known disease that is predominantly recognized in elderly people and repeatedly causes large subcortical hemorrhages. These hemorrhages may be derived from vessel wall weakness because of Abeta depositions in the wall of the cortical and leptomeningeal arteries. Although vessel ruptures in CAA have been thought to occur in cortical arteries, it was recently demonstrated that the primary hemorrhage occurs in the subarachnoid space, particularly the cerebral sulci, as a result of multiple ruptures of meningeal arteries in some cases of subcortical hematoma caused by CAA. CASE DESCRIPTION: Case patient 1 was a 74-year-old woman who presented with epilepticseizure. A restricted SAH in the right frontal lobe was observed on MRI. Thirty-three days later, left hemiparesis occurred suddenly and a huge subcortical hematoma was observed in the right frontal lobe on CT. The hematoma was removed, and the patient was pathologically diagnosed with amyloid angiopathy. Case patient 2 was a 73-year-old man who presented with epilepticseizure. A restricted SAH in the right frontal lobe was observed on MRI. Twenty days later, left hemiparesis occurred suddenly and a huge subcortical hematoma was observed in the right frontoparietal area on CT. Hematoma removal was performed on both patients, and they were diagnosed pathologically with amyloid angiopathy. CONCLUSIONS: We report on the cases of 2 patients with CAA who presented with epilepticseizure and were found to have a restricted subarachnoid hematoma in the cerebral sulcus on MRI before their subcortical hemorrhages occurred. Both cases were diagnosed pathologically. This demonstrated that vessel ruptures in CAA can occur in the subarachnoid space, particularly the cerebral sulci, as a result of ruptures of meningeal arteries. A restricted SAH on CT/MRI could be a warning sign of a huge subcortical hemorrhage in CAA.
Authors: Jennifer Linn; Frank A Wollenweber; Nina Lummel; Katja Bochmann; Thomas Pfefferkorn; Andreas Gschwendtner; Hartmut Bruckmann; Martin Dichgans; Christian Opherk Journal: J Neurol Date: 2012-07-22 Impact factor: 4.849
Authors: J Linn; A Halpin; P Demaerel; J Ruhland; A D Giese; M Dichgans; M A van Buchem; H Bruckmann; S M Greenberg Journal: Neurology Date: 2010-04-27 Impact factor: 9.910
Authors: S Kumar; R P Goddeau; M H Selim; A Thomas; G Schlaug; A Alhazzani; D E Searls; L R Caplan Journal: Neurology Date: 2010-03-16 Impact factor: 9.910
Authors: Eva Martínez-Lizana; María Carmona-Iragui; Daniel Alcolea; Manuel Gómez-Choco; Eduard Vilaplana; María B Sánchez-Saudinós; Jordi Clarimón; Mar Hernández-Guillamon; Josep Munuera; Ellen Gelpi; Beatriz Gómez-Anson; Manel de Juan-Delago; Raquel Delgado-Mederos; Joan Montaner; Angel Ois; Sergi Amaro; Rafael Blesa; Joan Martí-Fàbregas; Alberto Lleó; Juan Fortea Journal: J Cereb Blood Flow Metab Date: 2015-03-04 Impact factor: 6.200
Authors: V Cuvinciuc; A Viguier; L Calviere; N Raposo; V Larrue; C Cognard; F Bonneville Journal: AJNR Am J Neuroradiol Date: 2010-01-21 Impact factor: 3.825
Authors: Duangnapa Roongpiboonsopit; Andreas Charidimou; Christopher M William; Arne Lauer; Guido J Falcone; Sergi Martinez-Ramirez; Alessandro Biffi; Alison Ayres; Anastasia Vashkevich; Oluwole O Awosika; Jonathan Rosand; M Edip Gurol; Scott B Silverman; Steven M Greenberg; Anand Viswanathan Journal: Neurology Date: 2016-09-30 Impact factor: 9.910