Intracerebral hemorrhage due to cerebral amyloid angiopathy after head injury: Report of a case and review of the literature

Cerebral amyloid angiopathy (CAA) is an important cause of spontaneous intracerebral hemorrhage in the elderly. A few case reports of CAA‐related intracerebral hemorrhage after head injury, usually following a fall, have been published. More rarely, it may occur in the setting of a traffic accident, with only four cases having been reported. We describe a case of CAA‐related intracerebral hemorrhage in an 88‐year‐old man injured in a road traffic accident. The patient died 14 h after the accident. Autopsy examination revealed a left frontoparietal hematoma and CAA of most of the small leptomeningeal and cortical arteries, as well as several capillaries, predominantly in the parietal and occipital lobes. Except for bruises in the frontal and zygomatic regions, elbow and forearm, to the left, there were no skull fractures or traumatic lesions in other parts of the body. We review the literature on CAA‐related intracerebral hemorrhage associated with head injury. CAA‐related intracerebral hemorrhage after head injury may occur due to a minor trauma, minor and severe falls, or in the setting of a traffic accident. However, even in this last condition, it seems to happen mostly in patients who had a mild to moderate head injury. These facts show that replacement of the contractile components of the arterial tunica media by amyloid renders the affected cerebral blood vessels more vulnerable to head injury associated with acceleration and deceleration, independently of the severity of the dynamic loading acting on the head.