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Cerebral amyloid angiopathy without and with cerebral hemorrhages: A comparative histological study
Author(s) -
Vonsattel Jean Paul G.,
Myers Richard H.,
Tessa HedleyWhyte E.,
Ropper Allan H.,
Bird Edward D.,
Richardson Edward P.
Publication year - 1991
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410300503
Subject(s) - fibrinoid necrosis , cerebral amyloid angiopathy , medicine , pathology , necrosis , angiopathy , vasculitis , dementia , disease , diabetes mellitus , endocrinology
To identify those factors associated with cerebral hemorrhage among brains with cerebral amyloid angiopathy (CAA), we undertook a comparative postmortem histopathological study of amyloid‐containing vessels in the brains of patients with and without hemorrhage. Those without hemorrhage were represented by the following two groups: (1) elderly patients from a large general hospital (n = 66; age range, 75–107 years) and (2) patients with various neuropsychiatric disorders (n = 70; age range, 27–96 years). CAA was found in 45% of thefirst group and in 54% of the second group. The findings in these patients were compared with those in 17 brains in which both CAA and cerebral hemorrhage were present. We found that CAA was more severe in the brains with cerebral hemorrhage than in those without, and that fibrinoid necrosis was seen only in the brains with cerebral hemorrhage (12 of the 17 brains). Microaneurysms occurred only in the presence of severe, rather than moderate or mild, CAA. Serial sections in 2 brains of patients with cerebral hemorrhage showed fibrinoid necrosis, microaneurysms, and vascular rupture in close association with the hemorrhage. In 2 patients, hemorrhage was precipitated by trauma, and in 1, it was secondary to metastatic carcinoma. The features of brains from patients with CAA that are most consistently related to cerebral hemorrhage are (1) a severe degree of CAA and (2) the presence of fibrinoid necrosis, with or without microaneurysms.