What is the role of CT scanning in the workup of cerebral amyloid angiopathy (CAA)?

Updated: Dec 19, 2018
  • Author: Ravi S Menon, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

In computed tomography (CT) scanning, the finding of a single lobar hemorrhage with superficial location and cortical involvement with or without local extension to the subarachnoid and intraventricular spaces is suggestive of hemorrhage related to cerebral amyloid angiography (CAA). Evidence of multiple hemorrhages restricted to lobar regions may be present.

Hemorrhages are more common in the frontal and parietal lobes, involving the cortex and subcortical white matter. Over time, several lobes may be involved. Deep central gray nuclei, the corpus callosum, and the cerebellum are sometimes affected. CAA is rarely the cause of putaminal, thalamic, or brainstem hemorrhage.

Pure subarachnoid, intraventricular, and subdural hemorrhages can be seen but are rare. CAA should never be assumed to be the cause of an isolated subarachnoid hemorrhage unless all other causes, particularly aneurysmal, have been excluded.

Patients with CAA-associated dementia have leukoencephalopathy similar to that seen in Binswanger disease. Atrophy can also be detected, particularly in patients with cognitive impairment and a history of prior hemorrhage.


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