Taro Yanagawa1, Masaki Takao2, Masami Yasuda3, Tomoya Kamide4, Hiroki Sato4, Kaima Suzuki4, Toshiki Ikeda4, Yuichiro Kikkawa4, Hiroki Kurita4. 1. Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan. Electronic address: smile_880@yahoo.co.jp. 2. Department of Neurology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan. 3. Department of Pathology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan. 4. Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
Abstract
OBJECTIVE: To evaluate the clinical and histopathological features of elderly patients with subcortical intracerebral hemorrhage (ICH), and to analyze the presence of cerebral amyloid angiopathy (CAA) and Alzheimer's disease (AD) type pathologic changes using amyloid beta (Aβ) and tau immunohistochemistry. PATIENTS AND METHODS: We retrospectively analyzed cases satisfying the Boston criteria for CAA among patients with subcortical hemorrhage who underwent surgical removal by craniotomy at our hospital. Surgical specimens were subjected to hematoxylin and eosin (HE) staining as well as immunostaining. RESULTS: A total of 54 patients were included in this study, with a mean age of 74.5 years (range: 72.5-76.5 years, 95% confidence interval [CI]; 51% female). Of these 54 patients, 31 (57%) were hypertensive, 18 (33%) were undergoing antithrombotic therapy, and 12 (22%) had dementia. Strong immunoreactivity for Aβ40 in the cerebral vessels was observed in 30 patients (55.6%), and among these, 27 patients (90%) also showed strong immunoreactivity for Aβ42. Among the 54 patients, 25 (46%) exhibited AD characteristics, including Aβ-positive senile plaques and AT8-positive neurons. Multivariate analysis revealed that strong Aβ40 immunoreactivity in the cerebral vessels was associated with older patients, females, lack of high blood pressure, and the presence of AT8-positive neurons. CONCLUSION: CAA patients with strong Aβ40 deposition in the cerebral vessels were associated with subcortical hemorrhage in our cohort. Future studies should investigate the pathomechanism of ICH in individuals with CAA.
OBJECTIVE: To evaluate the clinical and histopathological features of elderly patients with subcortical intracerebral hemorrhage (ICH), and to analyze the presence of cerebral amyloid angiopathy (CAA) and Alzheimer's disease (AD) type pathologic changes using amyloid beta (Aβ) and tau immunohistochemistry. PATIENTS AND METHODS: We retrospectively analyzed cases satisfying the Boston criteria for CAA among patients with subcortical hemorrhage who underwent surgical removal by craniotomy at our hospital. Surgical specimens were subjected to hematoxylin and eosin (HE) staining as well as immunostaining. RESULTS: A total of 54 patients were included in this study, with a mean age of 74.5 years (range: 72.5-76.5 years, 95% confidence interval [CI]; 51% female). Of these 54 patients, 31 (57%) were hypertensive, 18 (33%) were undergoing antithrombotic therapy, and 12 (22%) had dementia. Strong immunoreactivity for Aβ40 in the cerebral vessels was observed in 30 patients (55.6%), and among these, 27 patients (90%) also showed strong immunoreactivity for Aβ42. Among the 54 patients, 25 (46%) exhibited AD characteristics, including Aβ-positive senile plaques and AT8-positive neurons. Multivariate analysis revealed that strong Aβ40 immunoreactivity in the cerebral vessels was associated with older patients, females, lack of high blood pressure, and the presence of AT8-positive neurons. CONCLUSION: CAA patients with strong Aβ40 deposition in the cerebral vessels were associated with subcortical hemorrhage in our cohort. Future studies should investigate the pathomechanism of ICH in individuals with CAA.