scholarly journals Isolated Central Sulcus Hemorrhage: A Rare Presentation Most Frequently Associated with Cerebral Amyloid Angiopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Murthy R. Chamarthy ◽  
Yogesh Kumar ◽  
Michael D. Meszaros ◽  
Ankit Shah ◽  
Mark A. Rosovsky
Keyword(s):  
Computed Tomography ◽  
Elderly Patient ◽  
Cerebral Amyloid Angiopathy ◽  
Imaging Finding ◽  
Amyloid Angiopathy ◽  
Central Sulcus ◽  
Rare Presentation ◽  
Cerebral Amyloidosis ◽  
Cerebral Amyloid ◽  
Work Up

Central sulcus hemorrhage is a rare imaging finding that can be related to cerebral amyloidosis in a normotensive non-traumatic elderly patient and present as an isolated finding or in association with other areas of involvement. We report a case presenting with an isolated central sulcus hemorrhage on computed tomography. Further imaging work-up excluded other potential causes of peripheral hemorrhages and established a putative diagnosis of cerebral amyloidosis.

Familial Cerebral Cavernous Malformation Mimicking Cerebral Amyloid Angiopathy

2021 ◽  
pp. 10.1212/CPJ.0000000000001055
Author(s):  
Mohamed Ridha ◽  
Yasmin Aziz ◽  
Joseph Broderick
Keyword(s):  
Cerebral Amyloid Angiopathy ◽  
Cavernous Malformation ◽  
Pathogenic Mutation ◽  
Cerebral Cavernous Malformation ◽  
Amyloid Angiopathy ◽  
History Of ◽  
Cerebral Amyloid ◽  
Cerebral Microhemorrhages ◽  
Familial Cerebral Cavernous Malformation ◽  
Work Up

A 67-year-old man was referred from ophthalmology for possible cerebral amyloid angiopathy (CAA) discovered during work-up of possible optic neuropathy. MRI (figure 1) demonstrated innumerable periventricular, brainstem, and cortical cerebral microhemorrhages (CMH). Scattered, non-specific white matter hyperintensities was seen on T2-weighted imaging without surrounding hypointense rim. He had no hypertension, and the distribution was uncharacteristic for CAA. Despite absent family history of stroke or seizure, testing for familial cerebral cavernous malformation (FCCM) identified a pathogenic mutation of KRIT1 (c.382G>T).

scholarly journals Occipital Cortical Calcifications in Cerebral Amyloid Angiopathy

Stroke ◽  
2021 ◽  
Vol 52 (5) ◽  
pp. 1851-1855
Author(s):  
Ingeborg Rasing ◽  
Sabine Voigt ◽  
Emma A. Koemans ◽  
Erik van Zwet ◽  
Paul C. de Kruijff ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Cerebral Amyloid Angiopathy ◽  
Occipital Cortex ◽  
Amyloid Angiopathy ◽  
Resonance Imaging ◽  
Striped Pattern ◽  
Mutation Carriers ◽  
Cerebral Amyloid

Background and Purpose: Cortical calcifications have been reported in patients with cerebral amyloid angiopathy (CAA), although their prevalence and pathophysiology are unknown. We investigated the frequency of calcifications on computed tomography, their association with intracerebral hemorrhage (ICH) and their coexistence with a striped pattern of the occipital cortex reflecting microcalcifications on ultra-high-field 7T-magnetic resonance imaging in Dutch-type hereditary CAA (D-CAA) and sporadic CAA. Methods: We included D-CAA mutation carriers with a proven APP (amyloid precursor protein) mutation or ≥1 lobar ICH and ≥1 first-degree relative with D-CAA and sporadic CAA patients with probable CAA according to the modified Boston criteria. D-CAA carriers were regarded symptomatic when they had a history of symptomatic ICH. We assessed the presence, location, and progression of calcifications and their association with ICH and the striped occipital cortex. Results: We found cortical calcifications in 15/81 (19% [95% CI, 11–29]) D-CAA mutation carriers (15/69 symptomatic and 0/12 presymptomatic) and in 1/59 (2% [95% CI, 0–9]) sporadic CAA patients. Calcifications were all bilateral located in the occipital lobes. In 3/15 (20%) of the symptomatic D-CAA patients the calcifications progressed over a period up to 10 years. There was evidence of an association between cortical calcifications and new ICH development (hazard ratio, 7.1 [95% CI, 0.9–54.9], log-rank P =0.03). In 7/25 D-CAA symptomatic carriers in whom a 7T-magnetic resonance imaging was performed, a striped pattern of the occipital cortex was present; in 3/3 (100%) of those with calcifications on computed tomography and 4/22 (18%) of those without calcifications. Conclusions: Occipital cortical calcifications are frequent in D-CAA but seem to be rare in sporadic CAA. Their absence in presymptomatic carriers and their association with ICH might suggest that they are a marker for advanced CAA. Cortical calcifications on computed tomography seem to be associated with the striped occipital cortex on 7T-magnetic resonance imaging which may possibly represent an early stage of calcification.

scholarly journals Anticoagulation Rationale in an Elderly Patient with Stroke, Cerebral Amyloid Angiopathy, and Antiphospholipid Syndrome: A Case Report

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Axel Ferreira ◽  
◽  
Filipa Guimarães ◽  
Paulo Simões Coelho
Keyword(s):  
Elderly Patient ◽  
Cerebral Amyloid Angiopathy ◽  
Antiphospholipid Syndrome ◽  
Amyloid Angiopathy ◽  
Past Medical History ◽  
Hemorrhagic Risk ◽  
Cerebral Amyloid ◽  
Cerebral Ischemic ◽  
Ischemic Events ◽  
Very High

We present a case of a 74-year-old woman with deep intracerebral hemorrhage (ICH), probable cerebral amyloid angiopathy (CAA), and probable antiphospholipid syndrome (APS). Due to the high hemorrhagic risk, it was decided not to use anticoagulants. In a period of three months, she had two separate cerebral ischemic events and died of stroke-related complications. The use of oral anticoagulation (OAC) in this patient is neither supported nor contra-indicated by current literature, even though past medical history suggests a very high ICH recurrence rate, probably contra-indicating the use of OAC.

Aura attacks from acute convexity subarachnoid haemorrhage not due to cerebral amyloid angiopathy

Cephalalgia ◽  
2010 ◽  
Vol 31 (3) ◽  
pp. 368-371 ◽  
Author(s):  
DK Field ◽  
TJ Kleinig
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Sinus Thrombosis ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Amyloid Angiopathy ◽  
Transient Ischaemic Attacks ◽  
Cerebral Amyloid ◽  
Diagnostic Work ◽  
Work Up

Background and purpose: Convexity subarachnoid haemorrhage (cSAH) has recently been recognised as a cause of recurrent aura-like symptoms, mimicking transient ischaemic attacks (TIAs). Subarachnoid haemorrhage and recurrent aura-like episodes can occur in patients with cerebral amyloid angiopathy (CAA), which has been the presumed cause in the majority of reported cases. However, this syndrome can occur following cSAH secondary to other conditions, and it is important for clinicians to investigate and manage such patients appropriately. Method: Case series. Results: We describe two patients who presented with recurrent stereotyped transient neurological symptoms in the setting of acute cSAH identified on MRI. In one patient, SAH occurred secondary to cerebral venous sinus thrombosis. In the other, SAH was due to extension of a traumatic subdural haematoma. Conclusions: Conditions other than CAA can cause the clinicoradiological syndrome of cSAH with recurrent TIA-like events. Gradient echo or susceptibility-weighted imaging should be included in the diagnostic work-up of patients presenting with such events. When cSAH is detected, the full differential diagnosis for this should be considered. Aetiologies other than CAA can cause this syndrome and management can vary greatly depending on the underlying cause.

scholarly journals Sensitivity of the Edinburgh Criteria for Lobar Intracerebral Hemorrhage in Hereditary Cerebral Amyloid Angiopathy

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3608-3612 ◽  
Author(s):  
Ellis S. van Etten ◽  
Kanishk Kaushik ◽  
Erik W. van Zwet ◽  
Sabine Voigt ◽  
Marianne A.A. van Walderveen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Linear Regression ◽  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Medical Center ◽  
Amyloid Angiopathy ◽  
Computed Tomography Scans ◽  
Median Volume ◽  
Cerebral Amyloid

Background and Purpose: The Edinburgh computed tomography and genetic criteria enable diagnosis of cerebral amyloid angiopathy (CAA) associated lobar intracerebral hemorrhage (ICH) but have not been validated in living patients. We assessed the sensitivity of the Edinburgh criteria in patients with acute lobar ICH due to Dutch-type hereditary CAA; a genetic and pure form of CAA. Methods: We retrospectively analyzed computed tomography-scans from a cohort of consecutive Dutch-type hereditary CAA patients who presented with ≥1 episode(s) of acute lobar ICH at the Leiden University Medical Center. Presence of subarachnoid hemorrhage (SAH) and finger-like projections (FLP) were determined. Association of SAH and FLP with ICH volume was analyzed using multivariate linear regression. Results: We included 55 Dutch-type hereditary CAA patients (mean age 56 years, 55% men) with a total of 107 episodes of acute lobar ICH. SAH was present in 82/107 (76%) and FLP in 62/107 (58%), resulting in a sensitivity of 76% for SAH and 58% for FLP. In 56 (52%), both markers were present. Nineteen (18%) lobar ICH showed no SAH extension or FLP. ICH volume was significantly associated with presence of SAH (median volume 4 versus 28 mL; P =0.001) and presence of FLP (median volume 7 versus 39 mL; P <0.001). With an ICH volume of ≥40 mL, the sensitivity of the presence of both SAH and FLP was >81% (95% CI, 70%–92%), whereas in ICH volumes <15 mL the sensitivity was <50%. Conclusions: The computed tomography-based Edinburgh criteria seem to be a sensitive diagnostic test for CAA-associated lobar ICH, although they should be used with caution in small-sized lobar ICH.

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