Cerebral hemorrhage with biopsy-proved amyloid angiopathy
W. H. Yong, M. E. Robert, D. L. Secor, T. J. Kleikamp and H. V. Vinters
Department of Pathology, UCLA School of Medicine 90024-1732.
Clinical, radiological, and immunohistochemical findings in brain biopsy
specimens from six patients with cerebral amyloid angiopathy-associated
intracerebral hemorrhage were reviewed. Acute clinical presentations
included headache, nausea and vomiting, loss of consciousness, and focal
neurological deficits such as hemiplegia and blindness. Transient ischemic
attacks experienced by one patient and referable to one hemisphere did not
indicate impending hemorrhage in that region. Computed tomographic scans
revealed acute, irregular, superficial, lobar hemorrhage with occasional
ring enhancement. Immunohistochemical studies were performed on biopsy
specimens using primary antibodies against portions of the Alzheimer A4
(beta-) peptide or gamma-trace peptide (the vascular amyloid protein in
patients with hereditary cerebral hemorrhage with amyloidosis-Icelandic
type). In all patients, anti-A4 and anti-gamma-trace labeled cerebral
microvessels. Immunoreactive senile plaques were few compared with the
numbers of stained microvessels. Reactive astrocytes in some patients were
labeled by both antiserum samples, suggesting uptake or production of these
proteins by the astrocytes. This study demonstrates the heterogeneous
clinical and radiological features of cerebral amyloid angiopathy-related
brain hemorrhage and the value of anti-A4 and anti-gamma-trace
immunohistochemical study of biopsy material from patients with suspected
cerebral amyloid angiopathy-related intraparenchymal bleeding.
