title: Rapidly Sequential and Fatal Hemorrhaging in a Case of Cerebral Amyloid Angiopathy.
abstract: BACKGROUND Cerebral amyloid angiopathy (CAA) is an increasingly recognized cause of lobar intracerebral hemorrhage (ICH) and cognitive impairment in the aging population. Magnetic resonance imaging (MRI) of cerebral microbleeds is the most reliable option for clinical diagnosis of suspected CAA. The pathophysiology of microbleeds and ICH in CAA is not well understood, but it is thought to be the result of vessel weakening and rupture secondary to amyloid deposition. Little evidence has been established pertaining to the time course of recurrent CAA-related microbleeds or larger hemorrhages. Although several risk factors have been associated with an increased risk of ICH in CAA, there are no current treatment guidelines for recurrent hemorrhaging in CAA. CASE REPORT We present a rare case of rapidly sequential and fatal lobar hemorrhaging in the setting of suspected CAA, diagnosed by numerous microbleeds on MRI, compounded by the use of subcutaneous heparin in a 63-year-old female patient. CONCLUSIONS This case broadens our understanding of a rarely identified progression of CAA and illustrates the need for further investigation of the use of subcutaneous heparin in the setting of probable CAA.
authors.affiliation: Department of Internal Medicine, University of Chicago - NorthShore University Health System, Evanston, IL, USA.
authors.forename: Zachary B
authors.initials: ZB
authors.lastname: Bulwa
authors.affiliation: Department of Family Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: G Carter
authors.initials: GC
authors.lastname: Ward
authors.affiliation: Department of Neurology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Owen
authors.initials: O
authors.lastname: Kramer
authors.affiliation: Department of Neurology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Birju
authors.initials: B
authors.lastname: Rao
authors.affiliation: Department of Neurology, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors.forename: Melvin
authors.initials: M
authors.lastname: Wichter
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D016657:Cerebral Amyloid Angiopathy / Q000150:complications* / Q000175:diagnosis; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014057:Tomography, X-Ray Computed