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Título

Lobar Intraparenchymatous Hemorrhage secondary to Amyloid Angiopathy in a young female: A Case Report

RESUMO

Case report: This case refers to a 44-years old female patient, who presented sudden
paresis of the right inferior limb (RIL) associated with frontoparietal lobar
intraparenquimatous hemorrhage in the left corticosubcortical region, and also
hypodense areas in the white matter. In the propaedeutic, it was performed Brain MRI,
it was visualized multiple foci of microbleedings in the cerebral and cerebellar
parenchymas, with alteration of white matter sign and recent hematoma in the high left
convexity associated with perivascular spaces. With these findings in the imaging,
compatible with small vessel disease (SVD), it was widened the investigation to
possible inflammatory etiologies (vasculitis, inflammatory amyloid angiopathy) with
performing of lumbar puncture to liquor study and it was initiated pulsotherapy with
methylprednisolone for five days. It was not detected any liquor alterations. There was
partial recovery of the deficits and the patient was discharged with ambulatorial follow-
up for etiology investigation. Nearly one year after the first event, she presented a new
neurologic deficit with complete right hemiparesis and right hypoesthesia, right
homonymous hemianopsia, and aphasia. Brain Tomography evidenced heterogenous
lobar intraparenquimatous hemorrhage in the high left frontal convexity, and also
demonstrated multiple foci of microbleedings with lobar distribution, characterizing
possible cerebral amyloid angiopathy, by the Boston Criteria.
Discussion: Cerebral Amyloid Angiopathy is a relevant etiology of Lobar Intraparenquimatous
Hemorrhage (LIH) and characterizes as deposits of beta-amyloid in small and medium
brain blood vessels, being strongly associated with age. Its prevalence is higher in
patients older than 65 years old and, in its occurrence in young ones, the medic must
hypothesize inflammatory and hereditary causes.
Final Comments: The investigation of LIH in young patients must be performed, as this is
one of the most common causes of cerebral venous thrombosis, arteriovenous
malformations, and vasculitis. The occurrence of amyloid angiopathy in these patients
must have the inflammatory and hereditary origins investigated and the institution of
therapeutic measures, as well as the control of risk factors is of extreme importance to
avoid the recurrence of bleeding, which could implicate in the loss of functionality and
worsen the individual life quality.

Palavras Chave

Cerebral Amyloid Angiopathy, Lobar Intraparenquimatous
Hemorrhage