Journal of Korean Society of Geriatric Neurosurgery 2019;15(2):56-64.
Published online September 30, 2019.
The Significance of Cerebral Amyloid Angiopathy-related Intracranial Hemorrhage
Je Hyoung Lee, Min Ho Kong, Soon O Hong, Se Youn Jang, Jung Hee Kim
Departments of Neurosurgery, Seoul Medical Center, Seoul, Korea
Cerebral amyloid angiopathy(CAA) is often associated with hemorrhagic stroke. This article reviews CAA-related intracerebral hemorrhages(CAA-ICH) and their cognitive and functional progression, including Alzheimer’s disease.
We retrospectively identified 30 cases of CAA-ICH and 69 cases of hypertensive ICH from hospital medical records between 2013 and 2016. Following the Boston guideline, we classified each CAA-ICH into 4 categories: (1) Definite CAA, (2) Probable CAA with supporting pathologic evidence, (3) Probable CAA, (4) Possible CAA. Clinical features were derived from medical record analysis, including ICH parameters, as well as functional and cognitive status, we also analyzed clinical outcomes and the results of radiologic investigations and surgical interventions.
The 30 cases of CAA-ICH consisted of 12 male and 18 female patients, with ages ranging from 55 to 93(mean 74.6). Mini-Mental State Examination(MMSE) and Modified Rankin Scale(mRS) scores ranged from 0 to 29(mean, 16.92) and 1 to 7(mean, 3.72±1.47) respectively. CAA-ICH patients showed a greater prevalence of preliminary cognitive impairments compared to hypertensive ICH patients(10, 33% vs 5, 7%, p<0.003), as well as higher rates of hemorrhage recurrence(11/30, 36.7% vs. 12/69, 17.4%, p<0.02). Clinical outcome analysis via mRS showed no significant difference between the two groups.
CAA-ICH is distinctive from its more common hypertensive counterpart, and our study has found that CAA-ICH patients displayed more advanced cognitive impairment and had higher rates of Alzheimer’s disease and hemorrhage recurrence. The expanding average life expectancy means that this will become an increasingly common issue for future neurosurgeons.
Key Words: Cerebral amyloid angiopathy, Cerebral hemorrhage, Recurrence, Alzheimer’s disease

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