Study of clinical features of amyloid angiopathy hemorrhage and hypertensive intracerebral hemorrhage.
OBJECTIVE
The purpose of this study was to differentiate between cerebral amyloid angiopathy (CAA) and hypertension (HTN) based on hemorrhage pattern interpretation.


METHODS
From June 1994 to Oct., 2000, 83 patients admitted to our service with acute intracerebral hemorrhage (ICH) were investigated retrospectively; 41 patients with histologically proven diagnosis of cerebral amyloid angiography and 42 patients with clear history of hypertension were investigated.


RESULTS
Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74.0 years vs 66.5 years, P < 0.05). There was a significantly higher number of hematomas > or = 30 ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglional hemorrhage was seen in CAA, but in 40.5% in HTN. In CAA-related ICH, subarachnoid hemorrhage (SAH) was seen in 26 patients (63.4%) compared to only 11 patients (26.2%) in HTN-related ICH. Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Typical features of CAA-related ICH included lobar distribution affecting mainly the lobar superficial areas, lobulated appearance, rupture into the subarachnoid space, and secondary IVH from the lobar hemorrhage. More specifically, multiplicity of hemorrhage, bilaterality, and repeated episodes also strongly suggest the diagnosis of CAA. Multiple hemorrhages, defined as 2 or more separate hematomas in multiple lobes, accounted for 17.1% in CAA-related ICH.


CONCLUSIONS
There are certain features in CAA on CT and MRI and in clinical settings. To some extent, these features may contribute to distinguishing CAA from HTN related ICH.
Zhan
Ren-ya
RY
Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China. ZRY1960@hzcnc.com
Tong
Ying
Y
Shen
Jian-feng
JF
Lang
E
E
Preul
C
C
Hempelmann
R G
RG
Hugo
H H
HH
Buhl
R
R
Barth
H
H
Klinge
H
H
Mehdorn
H M
HM
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D016657:Cerebral Amyloid Angiopathy / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index