Abstract
Lobar intracerbral hemorrhage with speical reference to amyloid angiopathy was investigated clinicopathologically in 2181 consecutive autopsied cases above 60 years of age (aged 60 to 106 years, with a mean of 77.4 years).
The result were as follows;
1) Spontaneous intracerebral hemorrhages were observed in 230 cases (10.5%) with 35 cases of multiple hemorrhage. The lobar type was found in 39 cases (17.0%) of intracerebral hemorrhage.
2) The causes of lobar hemorrhage consisted of hypertension in 14 (35.8%), amyloid angiopathy in 8 (20.5%), neoplasm in 6 (15.4%), hemorrhagic diathesis in 4 (10.3%), rupture of aneurysm in 3 (7.7%), vascular malformation in 1 (2.6%), and unknown etiology in 3 cases (7.7%).
3) Among 8 cases with lobar hemorrhage due to amyloid angiopathy, aged 71 to 92 years, 3 male and 5 female, dementia was present in 5 cases, and hypertension in 3 cases. Neuropathologically, hemorrhages involved the cortex to the white matter, with dissection into the subarachnoid space. Multiple lobar hemorrhages were found in 4 cases, and small cortical infarction in association with amyloid angiopathy, frequently multiple, was observed in 5 cases. Amyloid angiopathy was seen in small arteries and atrerioles of the meninges and cortex of the cerebrum, occasionally of the cerebellum, but was not entirely seen in subcortical white matter. Additionally, amyloid angiopathy in the basal ganglia and brain stem was observed only in 1 case. Five cases with dementia were pathologically classified in 3 types; that is, vascular dementia in 3, mixed type in 1, and Alzheimer type in 1 case.
In conclusion, amyloid angiopathy is an important etiological consideration for lobar intracerebral hemorrhage in the aged. Cerebral hemorrhage due to amyloid angiopathy is characterized by the lobar type involving the cortex, with direct extension into the subarachnoid space, frequently multiple hemorrhages and complicated with cortical infarctions, in elderly patients without risk factors. dementia is not necessary present, and if present, dementia of the vascular type shoud be taken into consideration.
