Cerebral Amyloid Angiopathy: Diagnosis and Management

Location and Imaging Characteristics

Lobar hemorrhages in elderly nonhypertensive patients are characteristically due to cerebral amyloid angiopathy (CAA), whereas deep hemorrhages in hypertensive patients typically result from chronic hypertension 1
Multiple juxtacortical microhemorrhages on susceptibility-weighted MRI sequences are highly specific for CAA and represent chronic hemorrhagic lesions from amyloid deposition in vessel walls 2, 3

Short-term memory loss is commonly associated with CAA due to shared pathophysiology involving β-amyloid deposition 4

Hypertensive hemorrhages typically occur in deep structures (basal ganglia, thalamus, pons, cerebellum) from rupture of penetrating subcortical vessels, not in lobar locations 1
The presence of multiple cortical microhemorrhages argues against isolated hypertensive arteriopathy 2
Hemorrhagic metastases would typically show surrounding vasogenic edema or an identifiable mass 3
Cerebral vein thrombosis would present with venous infarction with hemorrhagic transformation rather than isolated lobar hemorrhage 2
Vertebral artery dissection would cause posterior circulation ischemia or subarachnoid hemorrhage, not isolated occipital parenchymal hemorrhage 2

CAA-associated hemorrhages have an increased risk of recurrence compared to other intracerebral hemorrhage etiologies, particularly in lobar locations 6
Decision analysis studies recommend against anticoagulation in patients with lobar intracerebral hemorrhage, even in the presence of atrial fibrillation 7, 6

The underlying CAA pathology requires different long-term blood pressure management considerations than hypertensive arteriopathy 2