A Case of Multiple Intracerebral Hemorrhages Due to Early-Onset Cerebral Amyloid Angiopathy With Alzheimer’s Disease: Neuropathological Changes Three Decades After Childhood Neurosurgery

TL;DR

A 39-year-old woman developed early-onset cerebral amyloid angiopathy after childhood neurosurgery, leading to multiple brain hemorrhages.

Contribution

This case highlights early-onset cerebral amyloid angiopathy as a potential complication of childhood neurosurgery.

Findings

The patient had a history of childhood neurosurgery and later developed cerebral amyloid angiopathy.

Brain biopsy confirmed severe amyloid beta deposition in cerebral vessels.

Early-onset CAA should be considered in young patients with cerebral hemorrhages and a history of head trauma or neurosurgery.

Abstract

Cerebral amyloid angiopathy (CAA) is a disease in which amyloid beta (Aβ) is deposited in blood vessels and meninges in the brain. Cerebral amyloid angiopathy typically occurs in the elderly but is also known to occur in younger patients with a history of childhood head trauma or dura graft following neurosurgical procedures.

The patient was a 39-year-old female who had undergone neurosurgery for an arachnoid cyst in the right temporal lobe at the age of two years. Severe headache, dizziness, and right leg weakness developed abruptly. The Aβ42/40 ratio had decreased in cerebrospinal fluid. Brain MRI showed multiple cerebral hemorrhages. Considering CAA, a brain biopsy was performed. Pathological examination showed severe CAA in many leptomeningeal and cortical vessels.

We reported early-onset CAA after neurosurgery in childhood. In young patients with cerebral hemorrhages, it is necessary to consider early-onset CAA following childhood head trauma or neurosurgery.

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