Clinico-Radiological Characteristics and Pathological Diagnosis of Cerebral Amyloid Angiopathy-Related Intracerebral Hemorrhage

J Stroke Cerebrovasc Dis. 2016 Jul;25(7):1736-1745. doi: 10.1016/j.jstrokecerebrovasdis.2016.03.041. Epub 2016 Apr 14.


Objective: We aim to clarify the clinico-radiological characteristics of cerebral amyloid angiopathy-related intracerebral hemorrhage and to investigate the efficacy of pathological diagnosis using biopsy specimens.

Method: We retrospectively reviewed 253 consecutive patients with cortico-subcortical hemorrhage who had been admitted to Aizawa Hospital between January 2006 and July 2013. We had performed craniotomy and hematoma evacuation in 48 patients, as well as biopsy of the evacuated hematoma, cerebral parenchyma adjacent to the hematoma, or both, and they were classified according to the histological results (positive or negative for vascular amyloid deposition) and to the Boston criteria. We compared the clinico-radiological characteristics of cerebral amyloid angiopathy-related intracerebral hemorrhage. We also investigated the detection rate of cerebral amyloid angiopathy with respect to the origins of the specimens.

Results: Pathological examination revealed that 22 subjects were positive for vascular amyloid. The number of the cerebral microbleeds located in the deep or infratentorial region was significantly larger in the negative group than in the positive group (P <.05). There was no significant difference in the distribution of lobar cerebral microbleeds and in the prevalence of hypertension. In the probable cerebral amyloid angiopathy-related intracerebral hemorrhage patients, the probability of having vascular amyloid detected by biopsy of both hematoma and parenchyma was 100%. Rebleeding in the postoperative periods was observed in 2 cases (9.1%) of the positive group.

Conclusions: Our results demonstrate the importance and safety of biopsy simultaneously performed with hematoma evacuation. Deep or infratentorial microbleeds are less correlated with cerebral amyloid angiopathy-related intracerebral hemorrhage than with noncerebral amyloid angiopathy-related intracerebral hemorrhage.

Keywords: Cerebral amyloid angiopathy; biopsy; cerebral microbleeds; diagnosis; intracerebral hemorrhage.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amyloid beta-Peptides / analysis
  • Biomarkers / analysis
  • Biopsy
  • Brain / blood supply*
  • Brain / diagnostic imaging
  • Brain / pathology*
  • Brain / surgery
  • Brain Chemistry
  • Cerebral Amyloid Angiopathy / complications
  • Cerebral Amyloid Angiopathy / diagnostic imaging
  • Cerebral Amyloid Angiopathy / pathology*
  • Cerebral Amyloid Angiopathy / surgery
  • Cerebral Arteries / chemistry
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / pathology*
  • Cerebral Arteries / surgery
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / pathology*
  • Cerebral Hemorrhage / surgery
  • Craniotomy
  • Female
  • Hematoma / etiology
  • Humans
  • Immunohistochemistry
  • Japan
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Parenchymal Tissue / pathology
  • Predictive Value of Tests
  • Retrospective Studies
  • Tomography, X-Ray Computed


  • Amyloid beta-Peptides
  • Biomarkers