A restricted subarachnoid hemorrhage in the cortical sulcus in cerebral amyloid angiopathy: could it be a warning sign?
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 Abeta 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.


METHODS
Case patient 1 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.
Katoh
Masahito
M
Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo 060-0022, Japan. masasama@ceres.ocn.ne.jp
Yoshino
Masami
M
Asaoka
Katsuyuki
K
Aoki
Takeshi
T
Imamura
Hiroyuki
H
Kashiwazaki
Daina
D
Takano
Kazuya
K
Aida
Toshimitsu
T
D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D016657:Cerebral Amyloid Angiopathy / Q000150:complications* / Q000473:pathology*; D002540:Cerebral Cortex / Q000473:pathology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008576:Meningeal Arteries / Q000473:pathology; D009460:Neurologic Examination; D010291:Paresis / Q000209:etiology; D012640:Seizures / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
D000927:Anticonvulsants