Hereditary cerebral hemorrhage with amyloidosis-Dutch type (HCHWA-D): I--A review of clinical, radiologic and genetic aspects

Brain Pathol. 1996 Apr;6(2):111-4. doi: 10.1111/j.1750-3639.1996.tb00793.x.


Hereditary cerebral hemorrhage with amyloidosis-Dutch type (HCHWA-D) is an autosomal dominant disease caused by deposition of beta-amyloid in the leptomeningeal arteries and cortical arterioles, in addition to preamyloid deposits and amyloid plaques in the brain parenchyma. The disease is due to a point mutation at codon 693 of the amyloid precursor protein (beta PP) gene at chromosome 21. Since this point mutation is diagnostic for HCHWA-D, presymptomatic testing is feasible and offered, together with genetic counselling and psychological support, to subjects at risk. HCHWA-D is clinically characterized by recurrent strokes, in addition to dementia, which can occur after the first stroke but also preceding it. Radiological studies revealed focal lesions (hemorrhages, hemorrhagic and non-hemorrhagic infarctions) and diffuse white matter damage. Diffuse white matter hyperintensities on MRI are an early symptom of HCHWA-D since they have been found on MRI scans of subjects who had not suffered a stroke. The presence of the diagnostic point mutation makes HCHWA-D a useful model to study the effects of cerebral amyloid angiopathy in vivo. The characteristic pathological abnormalities and its implications for Alzheimer's disease will be discussed in Part II of this article.

Publication types

  • Review

MeSH terms

  • Amyloid beta-Protein Precursor / genetics*
  • Amyloidosis / diagnostic imaging
  • Amyloidosis / genetics*
  • Amyloidosis / physiopathology*
  • Arterioles / pathology
  • Brain / blood supply
  • Brain / diagnostic imaging
  • Brain / pathology
  • Brain Diseases / diagnostic imaging
  • Brain Diseases / genetics*
  • Brain Diseases / physiopathology*
  • Cerebral Arteries / pathology
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / genetics*
  • Cerebral Hemorrhage / physiopathology*
  • Cerebral Infarction / diagnostic imaging
  • Cerebral Infarction / genetics
  • Chromosomes, Human, Pair 21*
  • Genes, Dominant
  • Genetic Counseling
  • Humans
  • Point Mutation
  • Prognosis
  • Radiography


  • Amyloid beta-Protein Precursor