Presentation
Sudden loss of conciousness.
Patient Data
A large right-sided lobar hemorrhage with extension into the ventricle is present with marked mass effect.
Case Discussion
The patient went on to have an evacuation and biopsy.
Histology
Sections show abundant fresh blood clots, containing layers of degenerating neutrophils and fibrin alternating with red cells. In specimen 2 there is accumulation of blood beneath the leptomeninges, which contain scattered vessels of varying caliber showing mural thickening with some luminal narrowing, and amorphous eosinophilic material within the wall that is strongly suggestive of amyloid. Congo red stains this material, which shows apple-green birefringence on polarization. \XE1\A4 also stains the walls of the abnormal vessels. A small fragment of edematous cortex and white matter is sampled (specimen 1). This shows a mild astrocytosis. Only small capillary-sized vessels are seen, however, these are normal in appearance. There is no evidence of a vascular malformation.
FINAL DIAGNOSIS: lobar hematoma and leptomeningeal vessels showing cerebral amyloid angiopathy.
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