File:Cerebral amyloid angiopathy- multiple intracranial hemorrhages (Radiopaedia 40475-43044 Axial non-contrast 32).png

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Summary:

Description
  • Radiopaedia case ID: 40475
  • Image ID: 16757556
  • Image stack position: 32/35
  • Plane projection: Axial
  • Aux modality: non-contrast
  • Study description: CTA Brain (current presentation)
  • Study findings: A left cerebellar hemisphere acute hemorrhage is demonstrated, measuring 4 x 2.5 x 2.5 cm, with extension into the extra-axial space, with this component measuring 13 mm in depth. The overall effect is effacement of the posterior fossa basal cisterns and 4th ventricle, with enlargement of the 3rd and lateral ventricles consistent with developing hydrocephalus. Extensive patchy white matter hypoattenuation is in keeping with chronic small vessel ischemic change. CTA arch to vertex: Intradural vessels demonstrate no focal abnormality, specifically no evidence of avascular malformation or aneurysm related to the aforementioned left cerebellar hemisphere hemorrhage. No evidence of arteriovenous shunting to suggest a malformation or dural arteriovenous fistula. Incidental note is made a somewhat ectatic right extradural cavernous ICA, without defined aneurysm. Note is also made of both posterior inferior cerebellar arteries arising from the vertebral arteries at or just prior the entry through the dura. The extracranial circulation is largely unremarkable, with only moderate stenosis of the left internal carotid artery origin (50-65%). Minor multilevel degenerative change of the cervical spine is demonstrated, with no high-grade stenosis. Soft tissues of the neck are within normal limits. Conclusion: 1. Left cerebellar hemispheric hemorrhage with extra-axial extension in this clinical context (known poorly controlled hypertension) presumably represents a primary hypertensive hemorrhage. No underlying vascular abnormality evident. 2. developing hydrocephalus 3. moderate left ICA stenosis at it origin
  • Modality: CT
  • System: Central Nervous System
  • Findings: A relatively stable ill-defined 2 cm area of gliosis/encephalomalacia and hemosiderin staining, compatible with old hemorrhage, remains centered posteriorly in the left inferior and middle temporal gyri. There is no evidence of underlying tumor, vascular malformation or aneurysm. Of note, a linear focus of T2 hyperintensity and diffusion restriction, consistent with a recent small vessel infarct , is now noted to course obliquely through the posterior left parietal lobe subcortical white matter. A stable 2-3 cm area of partly liquefied encephalomalacia/gliosis remains centered inferiorly in the left occipital lobe, with moderately extensive chronic small vessel ischemic change elsewhere in the white matter of both cerebral hemispheres and brainstem considered excessive even for a 62 year old patient.The remainder of the study is unremarkable.
Date Published: 24th Oct 2015
Source https://radiopaedia.org/cases/cerebral-amyloid-angiopathy-multiple-intracranial-haemorrhages
Author RMH Neuropathology
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(Permission-reusing-text)		 http://creativecommons.org/licenses/by-nc-sa/3.0/

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