Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Pre-critical MRI findings of an Alzheimer's disease patient with pathologically proven cerebral amyloid angiopathy related lobar hemorrhage

Toshihiro Nonaka, M.D.1), Yusuke Yakushiji, M.D., Ph.D.1), Toshihiro Ide, M.D.1), Hiroshi Ito, M.D.2), Kazuhiro Kawamoto, M.Eng.1) and Hideo Hara, M.D., Ph.D.1)

1)Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
2)Department of Neurosurgery, Saga University Faculty of Medicine

An 85-year-old woman with untreated hypertension was admitted with a disturbance of consciousness. On admission, brain CT revealed a lobar intracerebral hemorrhage with a midline shift. An intracranial hematoma was evacuated via a life-saving craniotomy. Definite pathological findings of amyloid-β deposition in the excised hematoma (strong in anti-amyloid β40 immunostain, but weak in anti- amyloid β42) indicated cerebral amyloid angiopathy (CAA). She had been diagnosed with Alzheimer's disease at a regional memory clinic one month before symptom onset based on MRI findings of medial temporal lobe atrophy as well as CAA-related features of multiple strictly lobar cerebral microbleeds in the occipital lobe, cortical superficial siderosis and >20 enlarged perivascular spaces in the centrum semiovale. This experience suggests that comprehensive interpretation of such CAA-related findings on MRI might help to improve the management of cardiovascular risk factors for Alzheimer's disease.
Full Text of this Article in Japanese PDF (898K)

(CLINICA NEUROL, 56: 338|343, 2016)
key words: cerebral amyloid angiopathy, MRI, cerebral microbleeds, cortical superficial siderosis, enlarged perivascular spaces

(Received: 25-Dec-15)