Surgical intervention, biopsy and APOE genotype in cerebral amyloid angiopathy-related haemorrhage

Twelve patients who had surgical removal of a cerebral haematoma had a biop sy or autopsy diagnosis of cerebral amyloid angiopathy-related haemorrhage (CAAH). Ten had a cortical biopsy at the time of surgery and eight reports of these were interpreted as showing CAA to be the cause of the haemorrhage . The diagnosis in the remaining two was made at autopsy. Six patients had a biopsy and autopsy, resulting in a 67% (four of six) biopsy sensitivity. Amyloid beta-protein (A beta) immunohistochemistry was more sensitive than tinctorial stains in detecting CAA. As previously reported in CAAH there wa s an excess of patients with the APOE epsilon 2 allele (33% versus 16% in a control group). Four patients (33%) were alive at 3 months. Despite surgic al intervention, CAAH has a poor outcome in patients with impaired consciou sness. Clinical awareness of CAAH and use of A beta immunostaining may incr ease the diagnostic yield from cerebral biopsy.