Stroke due to spontaneous intracerebral haemorrhage

Cerebral amyloid angiopathy (CAA) accounts for a significant number of primary intracerebral haemorrhages (ICHs), specifically in the older population. A definitive diagnosis of cerebral amyloid angiopathy (CAA) can only be made on the basis of brain tissue biopsy showing deposits of amyloid in the cerebral vessel walls. In routine clinical practice the modified Boston criteria, which combine neuroimaging and clinical findings, are used in order to establish a probable diagnosis.

Boston criteria[67]Knudsen KA, Rosand J, Karluk D, et al. Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology. 2001 Feb 27;56(4):537-9. http://www.ncbi.nlm.nih.gov/pubmed/11222803?tool=bestpractice.com

Used to estimate the likelihood of underlying CAA as a cause of lobar ICH.

• Definite CAA: autopsy verification.

• Probable CAA with supporting pathology: single or multiple lobar haemorrhages with CAA identified on a biopsy or resection specimen.

• Probable CAA: multiple lobar haemorrhages that may include lobar microbleeds on magnetic resonance imaging (MRI) gradient-echo sequence; patient 55 years old or older.

• Possible CAA: single lobar haemorrhage; patient 55 years old or older.

NOTE: Other potential causes of single or multiple haemorrhages are excluded, such as thrombocytopenia or familial cavernous malformations. Haemorrhages and microbleeds should be present in the lobar regions only.