Cerebral Amyloid Angiopathy

Today, we discussed an elderly patient with a history of hemorrhagic strokes and vascular dementia presenting with "dizziness", found to have cerebral amyloid angiopathy. A few learning points: 

1) Key differentiating factors for peripheral vs. central vertigo: 

2) Illness script for cerebral amyloid antipathy (CAA): In patients over 60 often with Alzheimer's disease or vascular dementia, deposition of congophilic material in small to medium-sized blood vessels of the brain and leptomeninges weakens the structure of the vessel wall and makes them prone to bleeding, leading to a clinical picture of transient neurologic symptoms and spontaneous lobar hemorrhage.

The lobar location helps distinguish CAA-related ICH from hypertensive ICH that more commonly arises in the putamen, thalamus, and pons. However, CAA is the 2nd leading cause of hemorrhagic stroke after HTN. Check out this nice review of CAA in the BMJ. 

3) Treatment of CAA: Acute management of CAA-related ICH is similar to that as for other spontaneous ICH, including BP management

And, because anticoagulant and antiplatelet agents increase the frequency and severity of ICH, these should be avoided in individuals who have probable CAA. 

The important MRI correlates of CAA include: Cerebral micro bleeds, White matter changes (leukoaraiosis), Convexity subarachnoid hemorrhage, Cortical superficial siderosis, and Silent acute ischaemic lesions

The important MRI correlates of CAA include: Cerebral micro bleeds, White matter changes (leukoaraiosis), Convexity subarachnoid hemorrhage, Cortical superficial siderosis, and Silent acute ischaemic lesions