Pathology-Proven Cerebral Amyloid Angiopathy in a Patient with Spontaneous Intracerebral Hemorrhage

Authors

  • Muntadher Khaleefah Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA Author
  • Mangay Thandampallayam Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA Author
  • Hiba Al Dallal Department of Pathology and Laboratory Medicine, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA Author
  • Larry B Goldstein Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA Author
  • Kara Jo Swafford Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA Author

DOI:

https://doi.org/10.47363/JNRRR/2024(6)202

Keywords:

Neurology, Pathology, Spontaneous, Angiopathy

Abstract

Cerebral amyloid angiopathy (CAA) related intracerebral hemorrhage (ICH) accounts for 20% of all types of spontaneous ICH. Results of brain magnetic resonance imaging (MRI) supports the clinical diagnosis of suspected CAA and can help predict the future risk of ICH. A definitive diagnosis of CAA requires brain biopsy and histopathological analysis.

Here we report a case of a patient with biopsy proven CAA without any evidence of typical MRI brain markers of the condition as described in Boston criteria version 2.0.

A 63-year-old man with a history of hypertension, type 2 diabetes mellitus, coronary artery disease on aspirin, and melanoma presented to the emergency department with acute headache and confusion. He was not anticoagulated. He had no history of dementia or head trauma. CT head showed an acute left temporal-parietal ICH with 2 mm midline shift. CTA head and neck were unremarkable. MRI of the head with and without contrast demonstrated a left temporal ICH with no underlying mass and no evidence suggestive of amyloid angiopathy on susceptibility weighted imaging (SWI) sequence. The mechanism of ICH was thought to be due to hypertension or an underlying neoplasm given his history of melanoma. Surgical evacuation of the hemorrhage was performed and histology was suggestive for CAA.

Our case is noteworthy because the diagnosis of CAA was unsuspected based on MRI findings described in Boston criteria version 2.0.

Author Biographies

  • Muntadher Khaleefah, Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA

    Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA

  • Mangay Thandampallayam, Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA

    Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA

  • Hiba Al Dallal, Department of Pathology and Laboratory Medicine, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA

    Department of Pathology and Laboratory Medicine, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA

  • Larry B Goldstein, Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA

    Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA

  • Kara Jo Swafford, Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA

    Department of Neurology, University of Kentucky, 740 South Limestone, Lexington, KY, 40536, USA

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Published

2024-10-30

Issue

Vol. 6 No. 10 (2024): Volume 6 Issue 10

Section

Articles