Tijdschrift voor Geneeskunde

Publication date: 2010-01
Volume: 66 Pages: 425 - 431
ISSN: 0371-683X, 1784-9721
DOI: 10.2143/TVG.66.09.2000744
Publisher: Nederlandstalige Medische Faculteiten in België

Author:

Peetermans, Marijke
Vanderschueren, Philip ; Hermans, Frank ; Thijs, Vincent

Abstract:

Cerebral amyloid angiopathy (CAA) is an important cause of intracerebral hemorrhage in the elderly. The textbook example of CAA is a non-hypertensive patient over age 70 with multiple lobar intracerebral hemorrhages and ischemic lesions. Still, the diagnosis of CAA should also be considered in patients with a single intracerebral hemorrhage. For a definite diagnosis of CAA according to the Boston criteria, a histopathological confirmation is required, although surgery has no proven benefit in the treatment of most intracerebral hemorrhages. CT and MRI imaging may provide us clues to the diagnosis of CAA. Multifocal inhomogeneous hemorrhages occurring exclusively in corticosubcortical ("lobar") regions, together with microhemorrhages on T 2*-gradient echo MRI, are suggestive of CAA. Scientists and clinicians hope for more performant non-invasive diagnostic tests in the future. The clinical case illustrates the diagnostic difficulties encountered in patients with single lobar hemorrhages. A diagnosis of "possible CAA" was made without definite proof of microbleeds nor histopathological evidence.