An 80-year-old man is admitted for a sudden onset of aphasia and right hemiparesis. His history includes hypertension, well controlled with diet and cognitive deterioration in the last year under study by his neurologist. The emergency cranial CT scan shows a left frontal lobar hematoma without contrast uptake. What is the most probable cause of the hematoma?
Amyloid angiopathy is the most common cause of spontaneous non-hypertensive hemorrhage in elderly patients, and is usually lobar in location (as in the case). They often appear in association with Alzheimer's disease (CTO Manual). The response that may cause the most doubts is 2, hypertension, but the most frequent localizations are: putamen, thalamus, pons and cerebellum. Therefore, most of the time these are deep hemorrhages (CTO Manual). In addition, as a clue it tells us that the patient has well-controlled hypertension without drugs, although this data would not serve to rule out the response. Answer 1, a malformation is typical of young patients, rare in older people. It also decreases the chance of not finding a malformation with contrast-enhanced CT. Answer 4, a brain tumor, does not seem likely since the mass is not seen on CT, and as in the previous case, it is more difficult not to find such a lesion after contrast administration. Answer 3 does not seem correct since vasculitis is a rare entity and more so in older people.
Arteriovenous malformation masked by acute hematoma.
Chronic arterial hypertension.
Isolated vasculitis of the nervous system.
Brain tumor.
Cerebral amyloid angiopathy (congophilic angiopathy).
Answer 1, a malformation is typical of young patients, rare in older people.
the most frequent localizations are: putamen, thalamus, pons and cerebellum. Therefore, most of the time these are deep hemorrhages (CTO Manual).
Answer 3 does not seem correct since vasculitis is a rare entity and more so in older people.
Answer 4, a brain tumor, does not seem likely since the mass is not seen on CT, and as in the previous case, it is more difficult not to find such a lesion after contrast administration.
Amyloid angiopathy is the most common cause of spontaneous non-hypertensive hemorrhage in elderly patients, and is usually lobar in location (as in the case). They often appear in association with Alzheimer's disease (CTO Manual).