Upcoming Events
Log In
Pricing
Free Trial

Cerebral Amyloid Angiopathy

HIDE
PrevNext

0:01

Another source of the worst headache of life

0:04

is an intracranial hemorrhage secondary to

0:07

the entity of cerebral amyloid angiopathy.

0:11

So this may be, you may see CAA

0:13

for cerebral amyloid angiopathy.

0:16

This is a vasculopathy that is associated with

0:20

multiple intracranial hemorrhages usually.

0:24

Unassociated with the deep gray matter.

0:27

So we usually separate hypertensive bleeds, which

0:30

can cause deep gray matter hemorrhages and lobar

0:34

hemorrhages from amyloid angiopathy, which also

0:37

can cause a lobar hemorrhage, but usually without

0:40

involvement of the deep gray matter or the brainstem.

0:44

So here is a susceptibility weighted scan on MRI where

0:49

you see that the patient has a parenchymal hemorrhage.

0:52

Which is nice and round here in the Centrum

0:56

Semiovale of the left frontal lobe.

0:59

However, what you should also notice

1:01

is that there is blood products, which

1:03

is staining the surface of the brain.

1:07

This is pia hemocephalus.

1:10

So pia on the pia, the leptomeninges, if you

1:13

will, and blood products are staining those

1:18

structures so that it almost looks like someone

1:19

took a black magic marker and went around the

1:22

brain with, with this dark signal intensity.

1:25

Here's a second hemorrhage in the

1:26

same patient with amyloid angiopathy.

1:29

So the presence of multiple peripheral hemorrhages

1:34

with associated superficial hemosiderosis is typical of.

1:40

Amyloid angiopathy, amyloid angiopathy may also

1:43

have large lobar hemorrhages, but nowadays the

1:47

more typical pattern that we see are these small

1:51

microhemorrhages or peripheral hemorrhages, not

1:54

necessarily involving deep gray matter structures.

1:58

So in the differential diagnosis between

2:01

hypertensive bleeds, which we've seen previously.

2:05

With our thalamus and basal ganglia and

2:08

potentially hemorrhaging into the intraventricular

2:10

system, we have cerebral amyloid angiopathy.

2:14

If it's deep gray matter involvement,

2:16

more likely hypertensive bleed.

2:19

If there's brainstem involvement, more likely to

2:21

be hypertensive bleed if it's more of a peripheral

2:25

white matter microhemorrhage appearance,

2:27

more likely cerebral amyloid angiopathy.

2:30

If there's hemosiderosis of the

2:32

surface of the brain and pia.

2:34

More likely amyloid angiopathy.

2:37

Lobar hemorrhages can occur in both, but

2:41

out in the periphery, more likely amyloid

2:43

angiopathy, subarachnoid hemorrhage.

2:46

Well, both of them can cause subarachnoid

2:49

hemorrhage, particularly since the hypertensive

2:51

bleeds can bleed into the ventricular system.

2:53

And since the ventricular system communicates

2:56

with the subarachnoid system, you may see that.

2:59

Showing subarachnoid hemorrhage, but cerebral

3:02

amyloid angiopathy with a lobar hemorrhage is

3:05

more likely to bleed into the subarachnoid space.

3:08

And finally, intraventricular hemorrhage.

3:10

Because intraventricular hemorrhage often is caused by

3:14

deep gray matter involvement, such as the thalamus or

3:18

the basal ganglia, it's more common in a hypertensive

3:21

bleed than in cerebral amyloid angiopathy (CAA).

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

MRI

Emergency

Brain

Acquired/Developmental

© 2025 Medality. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy