Cerebral amyloid angiopathy in brains of patients dying of non traumatic cerebral hemorrhages

Background: Cerebral amyloid angiopathy is considered pathogenic in non tra umatic cerebral lobar hemorrhages. Aim; To study the frequency of cerebral amyloid angiopathy in brains of patients dying of non traumatic cerebral he morrhages. Material and methods: Thirty seven brains from patients, 25 men and aged 65 +/- 10 years old, with cerebral hemorrhages (14 lobar, 18 in ba sal ganglia and 5 in cerebellum or brainstem) were studied. As controls, th e brains of 30 subjects, 14 men and aged 64 +/- 16 years old, dying of non neurological causes were studied. Deep and cortical vessels were stained wi th hematoxylin eosin, Gomori, Thioflavin T and Bodian. Definitive cerebral amyloid angiopathy was diagnosed when amyloid deposition was observed in th e media of vessels. Results: Twenty six out of 32 patients dying of cerebra l hemorrhage and 3 of 21 controls had chronic hypertension. Cerebral amyloi d angiopathy was present in 19 of 37 brains of patients with cerebral hemor rhage and 13 of 30 control brains. In patients with hypertension, vascular changes independent of the location and volume of amyloid deposition, were observed. Such changes were dilatation, tortuousness, thickening of walls s pecially in muscular and adventitia and hyaline degeneration. Thirteen brai ns with hemorrhage had fibrinoid necrosis and 10 had microaneurysms. Conclu sions: In this series of patients, cerebral amyloid deposition was unspecif ic and its role in the pathogenesis of cerebral hemorrhages was not confirm ed. Hypertension was associated with vascular degenerative changes that can lead to cerebral hemorrhages.