title: Cerebral amyloid angiopathy causing large contralateral hemorrhage during surgery for lobar hemorrhage: a case report.
abstract: We report a rare case of cerebral amyloid angiopathy (CAA) causing large contralateral hemorrhage during surgery for lobar hemorrhage. A 62-year-old woman presented with lobar hemorrhage in the left frontal and parietal lobes recurring over the previous 1 month. Because we could not detect the origin of the lobar hemorrhage, we performed a biopsy around the lobar hemorrhage site with the removal of a hematoma. During the surgery, we identified acute brain swelling without bleeding from the operative field. Intraoperative computed tomography demonstrated new large lobar hemorrhage of the right parietal lobe, which we could promptly remove. Specimens around hematomas on both sides were pathologically diagnosed as CAA on immunohistochemical examination. After the surgery, she suffered from lobar hemorrhage three times in the space of only 3 months. To the best of our knowledge, there has been no reported case of CAA causing intracranial hemorrhage of another lesion during surgery. Neurosurgeons should know a possibility of intraoperative hemorrhage in surgeries for lobar hemorrhage caused by CAA.
authors.affiliation: Department of Neurosurgery, University of Fukui, Fukui, Japan. Electronic address: ari@u-fukui.ac.jp.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Arishima
authors.affiliation: Department of Neurosurgery, University of Fukui, Fukui, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Neishi
authors.affiliation: Department of Neurosurgery, University of Fukui, Fukui, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kodera
authors.affiliation: Department of Neurosurgery, University of Fukui, Fukui, Japan.
authors.forename: Ryuhei
authors.initials: R
authors.lastname: Kitai
authors.affiliation: Department of Neurosurgery, University of Fukui, Fukui, Japan.
authors.forename: Ken-ichiro
authors.initials: K
authors.lastname: Kikuta
mesh_terms: D001706:Biopsy; D016063:Blood Loss, Surgical; D016657:Cerebral Amyloid Angiopathy / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D011237:Predictive Value of Tests; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Cerebral amyloid angiopathy; intraoperative computed tomography; intraoperative hemorrhage; lobar hemorrhage; recurrent hemorrhage