Cerebral amyloid angiopathy with frequent intracerebral hemorrhage: A pitfall for neurosurgeons

SummaryA 69-year-old man, who was formerly fit and well without precipitating risk factors such as hypertension, suffered a right frontal lobar intracerebral hemorrhage (ICH). The hematoma was removed, and histopathology showed blood clots with no evidence of malignancy. Two days after the craniotomy, a new lobar ICH occurred in the right parietal lobe with subfalcine cerebral herniation. The hematoma was again removed via a decompressive craniectomy. Histopathology of the brain tissue overlying the hematoma demonstrated cerebral amyloid angiopathy (CAA). Four weeks after this, a recurrent ICH in the right parietal lobe was noted during a cystoscopic procedure. This time the hematoma was treated conservatively. One year later, another ICH in the left frontal lobe developed following a right femoral neck fracture. This ICH was again treated conservatively. From this example, we have learnt that histopathological diagnosis can be very helpful for atypical recurrent intracerebral hemorrhage. Once the diagnosis of CAA is confirmed, conservative treatment is the rule, and prompt alleviation of physical or psychological stress could minimize the chance of recurrent ICH.