Cerebral amyloid angiopathy
 Discussion of Cerebral amyloid angiopathy
- Cerebral amyloid angiopathy (CAA) is an important cause of spontaneous cortical-subcortical intracranial hemorrhage (ICH) in the normotensive elderly.
- Characterized by the deposition of ß-amyloid protein in the media and adventitia of small and medium-sized vessels of the cerebral cortex, subcortex, and leptomeninges.
- Both prevalence and severity with increases age (CAA is found in 33% of 60–70 year olds and 75% of those older than 90 years).
- CAA is underrecognized cause of cerebrovascular disease, clinically as well as at imaging, because many patients are asymptomatic and symptoms are nonspecific.
- Most common presentation of CAA is the development of a sudden neurologic deficit secondary to an acute ICH.
- Dementia in CAA may be seen prior to symptomatic ICH in 25%–40% of patients.
 Imaging Findings for Cerebral amyloid angiopathy
- CAA manifests radiologically as part or all of a constellation of findings including:
- Acute or chronic ICHs in a distinctive cortical-subcortical distribution
- CT allows rapid establishment of the presence or absence of an ICH and exclusion of an acute cerebral infarction.
- Nonenhanced head CT is the preferred imaging modality for initial work-up as it provides crucial information regarding the characteristics of the ICH, including size, location, shape, and extension to the extraaxial spaces
- If an ICH is present in a cortical-subcortical location suspicious for CAA, the patient should undergo additional evaluation with MR imaging.
- GRE is currently the most sensitive MR imaging sequence for detection of the chronic cortical-subcortical microhemorrhage.
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 References for Cerebral amyloid angiopathy
- Christine P. Chao, Amy L. Kotsenas, and Daniel F. Broderick. Cerebral Amyloid Angiopathy: CT and MR Imaging Findings. RadioGraphics 2006 26: 1517-1531.