Lobar hemorrhage secondary to cerebral amyloid angiopathy


The patient went on to have the hematoma evacuated and biopsy. 


Paraffin sections show fragments of blood clot and brain tissue which are replaced by inflamed vascular granulation tissue. These are densely infiltrated by CD68+ monocyte-macrophages. Accumulation of small lymphocytes around blood vessels is also noted. Some blood vessels show thickening and hyalinisation of their wall with positive immunostaining for A-beta protein.

No evidence of tumor is seen.

DIAGNOSIS: cerebral amyloid angiopathy with hemorrhage; organizing blood clot; brain tissue replaced by inflamed granulation tissue; no evidence of tumor seen.


Presumably the enhancement is due to 10 day delay between onset and MRI. 

The patient has been followed up for 4 years. This hematoma underwent expected evolution.

Subsequently they went on to develop an additional left sided lobar hemorrhage.