Cerebral amyloid angiopathy (CAA)

Findings

Head CT demonstrates bilateral temporal hemorrhage (left > right) with scattered small vessel ischemic disease.
Head MRI again demonstrates the two hemorrhages seen on the CT, in addition there are multiple scattered bilateral black dots with no significant mass effect. No extracerebral fluid collections are present, and there is no abnormal enhancement. There was no diffusion restriction.

Differential diagnosis:
- Cerebral amyloid angiopathy
- Hemorrhagic metastasis
- Hypertensive micro hemorrhages
- Multiple venous malformations


Diagnosis: Cerebral amyloid angiopathy


Key points

Common cause of atraumatic parenchymal hemorrhage in elderly, particularly those with dementia.
Lobar hemorrhage > microangiopathy > focal "amyloidoma" (least common).
CAA hemorrhages frequently spare the basal ganglia. By contrast, hypertensive hemorrhages frequently involve the basal ganglia.
15-20% of atraumatic intracerebral hemorrhage in normotensive patients > 60 yrs.
27-32% of normal elderly (autopsy).
82-88% in patients with Alzheimer disease (AD).
Also common in Down syndrome.