Lobar hemorrhage - cerebral amyloid angiopathy

Case contributed by Assoc Prof Frank Gaillard

Presentation

Left-sided upper limb numbness.

Patient Data

Age: 80 years
Gender: Male

Focal hemorrhage in the postcentral gyrus white matter on the right. No enhancement or abnormal vessels visible. Patchy chronic small vessel ischemic change. 

MRI

Day 3 post hemorrhage

Hemorrhage in the postcentral gyrus has no unexpected or solid enhancement and no abnormal vessels. Gradient echo images demonstrate extensive superficial hemosiderin and microhemorrhages strongly suggesting underlying cerebral amyloid angiopathy. 

MRI

8 months later

At the site of the previous hemorrhage involving the postcentral gyrus of the right hemisphere or focal region of hemosiderin staining with associated gliosis is noted.

Scattered throughout both cerebral hemispheres are numerous small punctate regions of susceptibility induced signal drop out, predominantly located peripherally (sparing the basal ganglia) and associated with extensive superficial siderosis. No significant posterior fossa siderosis can be identified. On phase-contrast images, these foci of old low signal do not demonstrate any features of calcification

White matter T2 hyperintensity associated with generalized volume loss and ex vacuo dilatation of the ventricle suggests chronic small vessel ischemic change.  No intra- or extra-axial collection or mass identified.

Conclusion:

Peripheral supratentorial microhemorrhages with superficial siderosis strongly suggests the diagnosis of cerebral amyloid angiopathy. 

Case Discussion

Cerebral amyloid angiopathy is the most common cause of primary lobar hemorrhages in the elderly and this distribution of microhemorrhages and hemosiderin staining is characteristic. 

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Case information

rID: 81563
Published: 6th Sep 2020
Last edited: 9th Sep 2020
Inclusion in quiz mode: Included

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