Cerebral amyloid angiopathy related lobar hemorrhage

Case contributed by Dr Hidayatullah Hamidi


Patients presented with acute neurological deterioration and decreased GCS. History of cognitive impairment for last few weeks with history of left side paresthesia for two days.

Patient Data

Age: 65 years
Gender: Female

Acute lobar hemotoma (isointense on T1WI and hypointense on T2WI with diffusion restriction and blooming artifact on T2* GRE sequence) is noted in the right parietal cortical-subcortical location involving the post central gyrus.

Grade III leukoencephalopathy (large confluent, symmetrical  T2WI and FLAIR hyper intensities involving deep white matter and centrum semiovale (sparing the U fibers) noted probably due to microangiopathic changes secondary to amyloid-ß peptide deposition in the arterial walls.

T2* GRE images show multiple small foci of susceptibility blooming in the bilateral cerebral cortical and subcortical locations.

Case Discussion

​The Boston criteria for probable cerebral amyloid angiopathy are:

  • appropriate clinical history 
  • Age ≥55 years
  • MR imaging: Multiple cortical-subcortical hematomas, which may be of varying ages and sizes, with no other clinical or radiologic cause of hemorrhage.

Case contributed by: Dr. Najibullah Rasouly and Dr. Hidayatullah Hamidi

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Case information

rID: 51736
Published: 23rd Mar 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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