J Korean Neurosurg Soc.  2015 Jul;58(1):30-35. 10.3340/jkns.2015.58.1.30.

Clinical Neuropathological Analysis of 10 Cases of Cerebral Amyloid Angiopathy-Related Cerebral Lobar Hemorrhage

• Li XQ
• Su DF
• Chen HS
• Fang Q

• KMID: 2067101
• DOI: http://doi.org/10.3340/jkns.2015.58.1.30

Abstract

OBJECTIVE
The clinical and pathological characteristics of 10 cases of cerebral amyloid angiopathy (CAA)-related cerebral lobar hemorrhage (CLH) that was diagnosed at autopsy were investigated to facilitate the diagnosis of this condition.
METHODS
The clinical characteristics of 10 cases of CAA-related CLH were retrospectively reviewed, and a neuropathological examination was performed on autopsy samples.
RESULTS
The 10 cases included two with a single lobar hemorrhage and eight with multifocal lobar hemorrhages. In all of the cases, the hemorrhage bled into the subarachnoid space. Pathological examinations of the 10 cases revealed microaneurysms in two, double barrel-like changes in four, multifocal arteriolar clusters in five, obliterative onion skin-like intimal changes in four, fibrinoid necrosis of the vessels in seven, neurofibrillary tangles in eight, and senile plaques in five cases.
CONCLUSION
CAA-related CLHs were located primarily in the parietal, temporal, and occipital lobes. These hemorrhages normally consisted of multiple repeated CLHs that frequently bled into the subarachnoid space. CAA-associated microvascular lesions may be the pathological factor underlying CLH.

Keyword

Cerebral amyloid angiopathy; Cerebral lobar hemorrhage; Neuropathology

MeSH Terms

Amyloid*
Autopsy
Cerebral Amyloid Angiopathy
Diagnosis
Hemorrhage*
Necrosis
Neurofibrillary Tangles
Occipital Lobe
Onions
Plaque, Amyloid
Rabeprazole
Retrospective Studies
Subarachnoid Space
Amyloid

Figure

• 

  Fig. 1 Pathologic findings of brain tissue in ten patients with cerebral amyloid angiopathy-related cerebral lobar hemorrhage (CAA-related CLH). A and B : The parietal meningeal small blood vessels under the Congo red staining revealed that the walls thickened, exhibited uniform orange changes, under the polarizing microscope, yellowish green birefringence could be seen (Congo red staining, ×40). C and D : The formation of tiny aneurysm could be seen in parietal meninges, and the vessel walls were yellowish green under the polarized light (Congo red staining, ×10). E : The formation of tiny arterial plexus could be seen in the parietal sulcus, with the walls exhibiting yellowish green refraction under the polarized light (Congo red staining, ×40). F : The neurofibrillary thickening and tangles could be seen in the parietal cerebral brain parenchyma, and the amyloid-like substance could be seen around (Silver staining, ×100).

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