Answer
The severity of angiopathy and fibrinoid necrosis closely correlate with the occurrence of intracranial hemorrhage (ICH). The most consistent clinical effect of cerebral amyloid angiopathy (CAA) is lobar ICH. Lobar ICH is associated with a lower mortality rate (11-32%) and a better functional outcome than are hypertensive deep ganglionic bleeds.
Of individuals with CAA-related hemorrhage, 25-40% have a recurrence, with the highest risk in the first year. Recurrent hemorrhages can occur simultaneously or several years later. They are associated with a high mortality rate (up to 40%).
In one series investigating lobar hemorrhage, the recurrence rate was reported to be 38% and the mortality rate high at 44%. Of the recurrences, 36% occurred in the same location.
Patients with a previous hemorrhage are at greater risk for subsequent hemorrhages than are those with no history. A history of hemorrhagic stroke before the index lobar hemorrhage can predict early recurrence of ICH.
Hypertension may exacerbate the tendency to suffer CAA-related hemorrhage and vice versa. Cortical petechial hemorrhage can be epileptogenic.
A higher number of ICHs at baseline on gradient-echo (GRE) magnetic resonance imaging (MRI) sequences is associated with a higher risk of future ICH, subsequent cognitive impairment, loss of independence, and death.
-
MRI Brain GRE 3.0 TeslaTop: Multiple scattered microbleeds in multiple vascular territories in patient with hyperhomocysteinemia and methylene-tetrahydrofolate reductase mutation. Middle: Acute parenchymal hematoma with typical appearance of right occipital microbleed and left parietal chronic microhemorrhage.Bottom: Microbleeds involving multiple lobes. Chronic hemorrhage in the left parietal lobe with typical slit-like appearance.
