A restricted subarachnoid hemorrhage cerebral amyloid angiopathy: could it be a warning sign?

被引:37
作者
Katoh, Masahito [1 ]
Yoshino, Masami [1 ]
Asaoka, Katsuyuki [1 ]
Aoki, Takeshi [1 ]
Imamura, Hiroyuki [1 ]
Kashiwazaki, Daina [1 ]
Takano, Kazuya [1 ]
Aida, Toshimitsu [1 ]
机构
[1] Hokkaido Univ, Neurosurg Memorial Hosp, Dept Neurosurg, Sapporo, Hokkaido 060, Japan
来源
SURGICAL NEUROLOGY | 2007年 / 68卷 / 04期
关键词
cerebral amyloid angiopathy; subarachnoid hemorrhage; warning sign; meningeal artery;
D O I
10.1016/j.surneu.2006.11.028
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Cerebral amyloid angiopathy is a well-known disease that is predominantly recognized in elderly people and repeatedly causes large subcortical hemorrhages. These hemorrhages may be derived from vessel wall weakness because of A beta depositions in the wall of the cortical and leptomeningeal arteries. Although vessel ruptures in CAA have been thought to occur in cortical arteries, it was recently demonstrated that the primary hemorrhage occurs in the subarachnoid space, particularly the cerebral sulci, as a result of multiple ruptures of meningeal arteries in some cases of subcortical hematoma caused by CAA. Case Description: Case patient I was a 74-year-old woman who presented with epileptic seizure. A restricted SAH in the right frontal lobe was observed on MRI. Thirty-three days later, left hemiparesis occurred suddenly and a huge subcortical hematoma was observed in the right frontal lobe on CT. The hematoma was removed, and the patient was pathologically diagnosed with amyloid angiopathy. Case patient 2 was a 73-year-old man who presented with epileptic seizure. A restricted SAH in the right frontal lobe was observed on MRI. Twenty days later, left hemiparesis occurred suddenly and a huge subcortical hematoma was observed in the right frontoparietal area on CT. Hematoma removal was performed on both patients, and they were diagnosed pathologically with amyloid angiopathy. Conclusions: We report on the cases of 2 patients with CAA who presented with epileptic seizure and were found to have a restricted subarachnoid hematoma in the cerebral sulcus on MRI before their subcortical hemorrhages occurred. Both cases were diagnosed pathologically. This demonstrated that vessel ruptures in CAA can occur in the subarachnoid space, particularly the cerebral sulci, as a result of ruptures of meningeal arteries. A restricted SAH on CT/MRI could be a warning sign of a huge subcortical hemorrhage in CAA. (C) 2007 Elsevier Inc. All rights reserved.
引用
收藏
页码:457 / 460
页数:4
相关论文
共 6 条
[1]   Commentary on 'Subcortical hematoma caused by cerebral amyloid angiopathy: Does the first evidence of hemorrhage occur in the subarachnoid space?' (Neuropathology 2003; 23, 254-261) [J].
Maia, LF ;
Botelho, L ;
Correia, MM .
NEUROPATHOLOGY, 2004, 24 (04) :354-355
[2]  
Maia LF, 2003, NEUROPATHOLOGY, V23, P254
[3]  
Mughal Majid, 2002, Conn Med, V66, P67
[4]   Cerebral amyloid angiopathies: A pathologic, biochemical, and genetic view [J].
Revesz, T ;
Ghiso, J ;
Lashley, T ;
Plant, G ;
Rostagno, A ;
Frangione, B ;
Holton, JL .
JOURNAL OF NEUROPATHOLOGY AND EXPERIMENTAL NEUROLOGY, 2003, 62 (09) :885-898
[5]   Subcortical hematoma caused by cerebral amyloid angiopathy: Does the first evidence of hemorrhage occur in the subarachnoid space? [J].
Takeda, S ;
Yamazaki, K ;
Miyakawa, T ;
Onda, K ;
Hinokuma, K ;
Ikuta, F ;
Arai, H .
NEUROPATHOLOGY, 2003, 23 (04) :254-261
[6]   Cerebral amyloild angiopathy: Pathogenesis and effects on the ageing and Alzheimer brain [J].
Weller, RO ;
Nicoll, JAR .
NEUROLOGICAL RESEARCH, 2003, 25 (06) :611-616