Outcome of cerebral amyloid angiopathic brain haemorrhage.
BACKGROUND
Abnormal amyloid protein can be deposited in the wall of cerebral arteries leading to fragility and intracerebral haematoma in patients with cerebral amyloid angiopathy. Diagnosis can be done only histologically. The indication of surgically treating intracerebral haemorrhage caused by amyloid angiopathy is controversial. There are studies showing a high mortality and a high rate of recurrent bleeding. Others show almost no recurrent bleeding and a very low mortality and a third party states that even when recurrent intracerebral haemorrhage occurs, re-evacuation should be performed. In the present retrospective study a population of 99 patients suffering from cerebral amyloid angiopathy-related cerebral haemorrhage has been studied, to investigate the surgical outcome.


METHODS
Ninety-nine patients were histologically diagnosed with cerebral amyloid angiopathy in our department from 1991-2004. The outcome has been established by the Glascow Outcome Score.


RESULTS
It could be shown that intraventricular bleeding and age >75 years increased the mortality after operative evacuation. Recurrent bleeding occurred in 22% of patients. After re-evacuation at least half of the patients survived leading to the suggestion to re-operate a recurrent bleeding since patients have a chance to survive even when the Glascow Outcome Score is 3. The overall mortality in the observed population was 16% and 11% had a very good neurological recovery based on a Glascow Outcome Score of 4-5. The operative outcome in amyloid angiopathy related intracerebral haemorrhage is similar to this of intracerebral haemorrhage induced by other causes like hypertensive bleeding.


CONCLUSIONS
Possible cerebral amyloid angiopathy is no contraindication for evacuation of brain-haematoma, and especially not in patients younger than 75 years old without an intraventricular haemorrhage.
Petridis
Athanasios K
AK
Department of Neurosurgery, University of Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse 10, 24106, Kiel, Germany. opticdisc@aol.com
Barth
Harald
H
Buhl
Ralf
R
Hugo
Heinz Hermann
HH
Mehdorn
H Maximilian
HM
D000368:Aged; D000369:Aged, 80 and over; D016657:Cerebral Amyloid Angiopathy / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D002552:Cerebral Ventricles / Q000098:blood supply; D005260:Female; D023261:Glasgow Outcome Scale; D006406:Hematoma / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome