SUBACUTE ENLARGING CEREBRAL HEMATOMA FROM AMYLOID ANGIOPATHY - CASE-REPORT

WE REPORT THE case of a 74-year-old woman who, during a 36-hour period , developed progressive, focal neurological deficits and eventual coma associated with a spontaneously enlarging intraparenchymal hematoma r esulting from cerebral amyloid angiopathy. The subacute, progressive e nlargement of the hematoma, confirmed by serial computed tomographic s cans, supports the hypothesis that hematomas enlarge in amyloid angiop athy as a result of the replacement of the contractile elements of the arterial wall by noncontractile amyloid protein. This interference wi th vasoconstriction, the first phase of hemostasis, may be supplemente d by local endothelial dysfunction causing alterations in the chemical mediators of hemostasis, thereby promoting hemorrhage and hematoma en largement.