More than 1400 necropsies performed on patients with either a nontraumatic
cerebral hemorrhage (400 cases) or with
dementia over the age of 55 (1010 cases), or both, have been reviewed. There were 15 cases in which a
cerebral hemorrhage had occurred together with
cerebral amyloid angiopathy all of whom had been demented. Eight of the 15 patients were hypertensive. The 7 non-hypertensives showing only the
amyloid change included two cases of "atypical"
Alzheimer's disease with acute neurological features, and 5 cases of
senile dementia (aged 72 to 78 years) coupled with focal
neurological disorders. In the hypertensive patients, aged 67 to 86 years, with a progressive dementing syndrome and acute neurological signs, multiple ball-like
hemorrhages (7 cases) and/or cerebral
hematomas (3 cases) were associated with a combination of
amyloid and hyalinar (hypertensive) angiopathy, often affecting segments of the same pial and cortical vessels. From these data and recent reports on lethal
cerebral hemorrhage occurring spontaneously or after
neurosurgical procedures in demented old people,
cerebral amyloid angiopathy, which is not necessarily associated with systemic
amyloidosis or severe (pre)senile cerebral degeneration, may be considered a rare but important cause of
cerebral hemorrhage in the aged. The "vascular" type of
presenile dementia, occasionally complicated by focal cerebrovascular lesions or bleeds, is considered a variant of
Alzheimer's disease. The mechanism leading to formation of cerebral
amyloid is unknown.