Autopsy study of incidence and distribution of cerebral amyloid angiopathy in Hisayama, Japan.

Abstract

The incidence of cerebral amyloid angiopathy in a general population was evaluated in brains of 400 consecutive autopsies of residents of Hisayama, Japan (November 1971-October 1983). Six samples taken from frontal lobe, parietal lobe, temporal lobe, occipital lobe, hippocampus, and basal ganglia of the same side of each brain were stained with both hematoxylin and eosin and Congo red. The specimens were surveyed microscopically with polarized light for deposition of amyloid in the vascular wall. In 26 cases with brain hemorrhage, the region surrounding the hemorrhagic sites was further examined to study the probable causal relation between cerebral amyloid angiopathy and brain hemorrhage. Cerebral amyloid angiopathy was found in 40 of 218 men (18.3%) and 51 of 182 women (28.0%). The incidence increased with age in both sexes. The frontal lobe was most frequently affected (66 cases), followed by parietal lobe (65), occipital lobe (49), temporal lobe (44), and hippocampus (32); the putamen was never affected. The incidence of cerebral amyloid angiopathy did not correlate with blood pressure or with the severity of cerebral atherosclerosis. Among the 26 cases in which there was brain hemorrhage, only one cerebellar hemorrhage, in an 85-year-old man, was attributed to cerebral amyloid angiopathy. This case showed four microaneurysms in vessels, with cerebral amyloid angiopathy surrounding the hemorrhagic site. Thirty similar lesions were observed in eight cases without brain hemorrhage. Cerebral amyloid angiopathy may play an etiologic role in the development of brain hemorrhage through formation of angionecrosis and microaneurysm.

Diagnostic Accuracy and Yield of Multidetector CT Angiography in the Evaluation of Spontaneous Intraparenchymal Cerebral Hemorrhage

“…These results are similar to those reported in prior studies, in which cerebral amyloid angiopathy has been associated with 20%-75% of lobar IPHs in older patients. 22,[25][26][27] In addition, hemorrhagic cavernous malformations and brain tumors were found, on average, in patients 21 and 6 years younger than the average patient in our study, respectively-though these were distributed over a broad age range. Hence, if the initial CTA examination is negative, a contrast-enhanced MR imaging examination with a gradient-echo susceptibility sequence should be performed to evaluate for amyloid angiopathy and brain tumors in older patients, and for cavernous malformations and brain tumors in younger patients.…”

Hypertension and cerebral white matter lesions in a prospective cohort study

“…A possible candidate is (familial) cerebral amyloid angiopathy, which leads to weakening of the small and medium-sized arteries by the deposition of amyloid deposits in the vessel wall (MaatSchieman et al, 1996;Bornebroek et al, 1997). Hereditary forms of cerebral amyloid angiopathy are rare, whereas the prevalence of the sporadic form increases from 10% in persons aged 60±70 years to 50% for those aged >90 years (Masuda et al, 1988). White matter lesions are also observed frequently among non-hypertensives with CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy).…”

Descriptive Analysis of the Boston Criteria Applied to a Dutch-Type Cerebral Amyloid Angiopathy Population

“…Brain autopsy studies demonstrated that CAA pathology occurs with a prevalence ranging from 2% at the age of 50 years old to 74% in subjects Ͼ90 years old. [1][2][3][4][5][6][7] Moreover, 92% to 98.5% of patients with Alzheimer disease also have CAA. 1,7 A distinct type of CAA with a genetic basis is called hereditary cerebral hemorrhage with amyloidosis-Dutch type (HCHWA-D).…”