Cerebral amyloid angiopathy-associated lobar intracerebral hemorrhage

Case contributed by Mark Rodrigues
Diagnosis certain


Found collapsed.

Patient Data

Age: 80 years
Gender: Female

Images degraded by patient movement.

Acute right occipital hematoma involving the cortex and subcortical white matter. Localized subarachnoid hemorrhage. No sub/extradural or intraventricular hemorrhage.

Moderate periventricular low attenuation in keeping with small vessel disease. Mild generalized cerebral volume loss

Images degraded by patient movement.

Signal drop out in the right occpital lobe on GRE consistent with a hematoma. Localized cortical superficial siderosis. No definite microbleeds and no other macrohaemorrages.

Moderate white matter hyperintensities.

Case Discussion

Right occipital lobar hemorrhage with involvement of the cortex, extension into the subarachnoid space. Background changes of cortical superficial siderosis, and small vessel disease (white matter hyperintensities) and mild atrophy.

Lobar intracerebral hemorrhage is frequently attributed to small vessel diseases (cerebral amyloid angiopathy or arteriolosclerosis). Differentiating lobar hemorrhage due to cerebral amyloid angiopathy and arteriolosclerosis is important due to differences in recurrent ICH and post-stroke dementia risk (higher with CAA-associated ICH).

The initial CT shows subarachnoid hemorrhage but no finger-like projections from the hematoma. The patient possessed at least one APOE e4 allele. Therefore they are high risk for CAA-associated ICH on the Edinburgh CT and genetic diagnostic criteria for lobar intracerebral hemorrhage associated with cerebral amyloid angiopathy.

This patient has a single lobar macrohaemorrhage and focal cortical superficial siderosis and so is probable CAA on the modified Boston criteria.


PATHOLOGY: Post mortem showed a right occipital lobar hematoma with extensive cerebral amyloid angiopathy and vasculopathic changes. Mild small vessel disease. Alzheimer's-type pathology (Braak and Braak stage 4).

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.