Document Detail

Subcortical hematoma caused by cerebral amyloid angiopathy: does the first evidence of hemorrhage occur in the subarachnoid space?
MedLine Citation:
PMID:  14719539     Owner:  NLM     Status:  MEDLINE    
Six autopsy cases of subcortical hematoma caused by CAA were examined to elucidate the primary site of hemorrhage. Immunohistochemistry for amyloid beta-protein (A beta) revealed extensive CAA in the intrasulcal meningeal vessels rather than in the cerebral cortical vessels. All of the examined cases had multiple hematomas in the subarachnoid space, mainly in the cerebral sulci, as well as intracerebral hematomas. Each intracerebral hematoma was connected to the subarachnoid hematomas at the depth of cerebral sulci or through the lateral side of the cortex. There was no debris of the cerebral cortical tissue in the subarachnoid hematomas. In case 2, another solitary subarachnoid hematoma, which was not connected to any intracerebral hematoma, was seen. In all of these subarachnoid hematomas, many ruptured A beta-immunopositive arteries were observed. These ruptured arteries did not accompany any debris of the brain tissue, some of them were large in diameter (250-300 microm), and several of them were far from the cerebral cortex. Therefore, it was considered that they were not cortical arteries but meningeal arteries. Within the cerebral cortex, there were only a few ruptured arteries associated with small hemorrhages. There were no ruptured vessels within the intracerebral hematomas. There was a strong suggestion that all of the subarachnoid hematomas, including the solitary one in case 2, originated from the rupture of the meningeal arteries. The present study indicates that in some cases of subcortical hematoma caused by CAA, the primary hemorrhage occurs in the subarachnoid space, in particular the cerebral sulci, because of rupture of multiple meningeal arteries. Infarction occurs subsequently in the cortex around the hematoma, the hematoma penetrates into the brain parenchyma, and finally, a subcortical hematoma is formed.
Shigeki Takeda; Kazunori Yamazaki; Teruo Miyakawa; Kiyoshi Onda; Kaoru Hinokuma; Fusahiro Ikuta; Hiroyuki Arai
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neuropathology : official journal of the Japanese Society of Neuropathology     Volume:  23     ISSN:  0919-6544     ISO Abbreviation:  Neuropathology     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2004-01-14     Completed Date:  2004-03-12     Revised Date:  2008-03-10    
Medline Journal Info:
Nlm Unique ID:  9606526     Medline TA:  Neuropathology     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  254-61     Citation Subset:  IM    
Department of Pathology, Niigata Neurosurgical Hospital, Yamada, Niigata, Japan.
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MeSH Terms
Aged, 80 and over
Cerebral Amyloid Angiopathy / complications,  pathology*
Cerebral Cortex / blood supply,  pathology
Hematoma / etiology,  pathology*
Meninges / blood supply
Subarachnoid Hemorrhage / etiology,  pathology*
Comment In:
Neuropathology. 2004 Dec;24(4):354-5   [PMID:  15641599 ]

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