0:01

Another source of the worst headache of life

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is an intracranial hemorrhage secondary to

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the entity of cerebral amyloid angiopathy.

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So this may be, you may see CAA

0:13

for cerebral amyloid angiopathy.

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This is a vasculopathy that is associated with

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multiple intracranial hemorrhages usually.

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Unassociated with the deep gray matter.

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So we usually separate hypertensive bleeds, which

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can cause deep gray matter hemorrhages and lobar

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hemorrhages from amyloid angiopathy, which also

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can cause a lobar hemorrhage, but usually without

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involvement of the deep gray matter or the brainstem.

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So here is a susceptibility weighted scan on MRI where

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you see that the patient has a parenchymal hemorrhage.

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Which is nice and round here in the Centrum

0:56

Semiovale of the left frontal lobe.

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However, what you should also notice

1:01

is that there is blood products, which

1:03

is staining the surface of the brain.

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This is pia hemocephalus.

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So pia on the pia, the leptomeninges, if you

1:13

will, and blood products are staining those

1:18

structures so that it almost looks like someone

1:19

took a black magic marker and went around the

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brain with, with this dark signal intensity.

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Here's a second hemorrhage in the

1:26

same patient with amyloid angiopathy.

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So the presence of multiple peripheral hemorrhages

1:34

with associated superficial hemosiderosis is typical of.

1:40

Amyloid angiopathy, amyloid angiopathy may also

1:43

have large lobar hemorrhages, but nowadays the

1:47

more typical pattern that we see are these small

1:51

microhemorrhages or peripheral hemorrhages, not

1:54

necessarily involving deep gray matter structures.

1:58

So in the differential diagnosis between

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hypertensive bleeds, which we've seen previously.

2:05

With our thalamus and basal ganglia and

2:08

potentially hemorrhaging into the intraventricular

2:10

system, we have cerebral amyloid angiopathy.

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If it's deep gray matter involvement,

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more likely hypertensive bleed.

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If there's brainstem involvement, more likely to

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be hypertensive bleed if it's more of a peripheral

2:25

white matter microhemorrhage appearance,

2:27

more likely cerebral amyloid angiopathy.

2:30

If there's hemosiderosis of the

2:32

surface of the brain and pia.

2:34

More likely amyloid angiopathy.

2:37

Lobar hemorrhages can occur in both, but

2:41

out in the periphery, more likely amyloid

2:43

angiopathy, subarachnoid hemorrhage.

2:46

Well, both of them can cause subarachnoid

2:49

hemorrhage, particularly since the hypertensive

2:51

bleeds can bleed into the ventricular system.

2:53

And since the ventricular system communicates

2:56

with the subarachnoid system, you may see that.

2:59

Showing subarachnoid hemorrhage, but cerebral

3:02

amyloid angiopathy with a lobar hemorrhage is

3:05

more likely to bleed into the subarachnoid space.

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And finally, intraventricular hemorrhage.

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Because intraventricular hemorrhage often is caused by

3:14

deep gray matter involvement, such as the thalamus or

3:18

the basal ganglia, it's more common in a hypertensive

3:21

bleed than in cerebral amyloid angiopathy (CAA).