Neurosurgical Review

, Volume 36, Issue 4, pp 533–539

The incidence of cerebral amyloid angiopathy in surgically treated intracranial hemorrhage in the Chinese population

  • Ya-juan Tang
  • Yong Li
  • Shuo Wang
  • Ming-wei Zhu
  • Yi-lin Sun
  • Ji-zong Zhao
Original Article


Despite being widely accepted as an important cause of spontaneous intracranial hemorrhage (ICH), cerebral amyloid angiopathy (CAA) has seldom been studied in the Chinese population. The current study aims to investigate the incidence and features of CAA in surgically treated ICH patients in China. From May 2006 to April 2011, 974 patients admitted to 71 hospitals throughout China for acute spontaneous ICH were studied. Craniotomy for hematoma evacuation was performed. Brain tissue from the superficial side of the suspected residual hematoma cavity, as well as from the cortex and subcortex, was obtained. Congo Red stain and β-amyloid immunohistochemistry were used for the diagnosis. Each case was assigned a pathological severity score. Of the 974 involved patients, 37.7 % were identified with CAA of different degrees. CAA had positive correlation with age and was independent of sex. Most patients had mild CAA with only the superficial vessels involved in lobes instead of the basal ganglia; the patients ≥65 years had more severe pathological score of CAA than those <65 years and had more lobes and cerebellum involved than the latter. More than one third of the surgically treated Chinese ICH patients may have CAA of different degrees.


Cerebral amyloid angiopathy Chinese Hypertension Intracranial hemorrhage Neurosurgery 

Supplementary material

10143_2013_474_MOESM1_ESM.doc (74 kb)
ESM 1(DOC 73 kb)


  1. 1.
    Jellinger KA (2002) Alzheimer disease and cerebrovascular pathology: an update. J Neural Transm 109:83–836Google Scholar
  2. 2.
    Biffi A, Greenberg SM (2011) Cerebral amyloid angiopathy: a systematic review. J Clin Neurol 7:1–9PubMedCrossRefGoogle Scholar
  3. 3.
    Vinters HV (1987) Cerebral amyloid angiopathy. A critical review. Stroke 18:311–324PubMedCrossRefGoogle Scholar
  4. 4.
    Gould DB, Phalan FC, Mil SE, Sundberg JP, Vahedi K, Miner JH, Tournier-Lasserve E, John SWM (2006) Role of COL4A1 in small-vessel disease and hemorrhagic stroke. N Engl J Med 354:1489–1496PubMedCrossRefGoogle Scholar
  5. 5.
    Vinters HV, Gilbert JJ (1983) Cerebral amyloid angiopathy: incidence and complications in the aging brain. II. The distribution of amyloid vascular changes. Stroke 14:924–928PubMedCrossRefGoogle Scholar
  6. 6.
    Masuda J, Tanaka K, Ueda K, Omae T (1988) Autopsy study of incidence and distribution of cerebral amyloid angiopathy in Hisayama, Japan. Stroke 19:205–210PubMedCrossRefGoogle Scholar
  7. 7.
    Vernooij MW, Lugt A, Ikram MA, Wielopolski PA, Niessen WJ, Hofman A, Krestin GP, Breteler MMB (2008) Prevalence and risk factors of cerebral microbleeds: the Rotterdam Scan Study. Neurology 70:1208–1214PubMedCrossRefGoogle Scholar
  8. 8.
    Rosand J, Hylek EM, O'Donnell HC, Greenberg SM (2000) Warfarin-associated hemorrhage and cerebral amyloid angiopathy:a genetic and pathologic study. Neurology 55:947–951PubMedCrossRefGoogle Scholar
  9. 9.
    Leclercq PD, Murray LS, Smith C, Graham DI, Nicoli JAR, Gentleman SM (2005) Cerebral amyloid angiopathy in traumatic brain injury: association with apolipoprotein E genotype. J Neurol Neurosurg Psychiatry 76:229–233PubMedCrossRefGoogle Scholar
  10. 10.
    Vinters HV, Wang ZZ, Secor DL (1996) Brain parenchymal and microvascular amyloid in Alzheimer's disease. Brain Pathol 6:179–195PubMedCrossRefGoogle Scholar
  11. 11.
    Huaizhu F (2006) The analysis and prediction of life expectancy in our country. Northwest Popul 109:47–49Google Scholar
  12. 12.
    Dan X, Yang C, Wang L (2003) Cerebral amyloid angiopathy in aged Chinese: a clinico-neuropathological study. Acta Neuropathol 106:89–91Google Scholar
  13. 13.
    Ng TH, Leung SY, Wong MP (1991) Cerebral amyloid angiopathy in Chinese: incidence and significance. Clin Neurol Neurosurg 93:19–23PubMedCrossRefGoogle Scholar
  14. 14.
    Greenberg SM, Vonsattel JPG (1997) Diagnosis of cerebral amyloid angiopathy. Sensitivity and specificity of cortical biopsy. Stroke 28:1418–1422PubMedCrossRefGoogle Scholar
  15. 15.
    Vonsattel JP, Myers RH, Hedley-Whyte ET, Ropper AH, Ed B, Ep R (1991) Cerebral amyloid angiopathy without and with cerebral hemorrhages: a comparative histological study. Ann Neurol 30:637–649PubMedCrossRefGoogle Scholar
  16. 16.
    Olichney JM, Hansen LA, Hofstetter CR, Grundman M, Katzman R, Thal LJ (1995) Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension. Arch Neurol 52:702–708PubMedCrossRefGoogle Scholar
  17. 17.
    Thal DR, Ghebremedhin E, Orantes M, Wiestler OD (2003) Vascular pathology in Alzheimer's disease: correlation of cerebral amyloid angiopathy and arteriosclerosisélipohyalinosis with cognitive decline. J Neuropathol Exp Neurol 62:1287–1301PubMedGoogle Scholar
  18. 18.
    Tang YJ, Wang S, Zhu MW, Sun YL, Zhao JZ (2013) Severe pathological manifestation of cerebral amyloid angiopathy correlates with poor outcome from cerebral amyloid angiopathy related intracranial hemorrhage. Chin Med J 126(4):603–608Google Scholar
  19. 19.
    Mesker DJ, Poels MM, Ikram MA, Vernoij MW, Vrooman HA, van der Lugt A, Breteler MM (2011) Lobar distribution of cerebral amyloid microbleeds: the Rotterdam Scan Study. Arch Neruol 68:656–659CrossRefGoogle Scholar
  20. 20.
    Attems J, Jellinger KA, Lintner F (2005) Alzheimer's disease pathology influences severity and topographical distribution of cerebral amyloid angiopathy. Acta Neuropathol 110:222–231PubMedCrossRefGoogle Scholar
  21. 21.
    Wright JR, Calkins E, Breen WJ, Stolte G, Schultz RT (1969) Relationship of amyloid to aging. Review of the literature and systematic study of 83 patients derived from a general hospital population. Medicine (Baltimore) 48:39–60Google Scholar
  22. 22.
    Leblanc R, Preul M, Robitaille Y, Villemure JG, Pokrupa R (1991) Surgical considerations in cerebral amyloid angiopathy. Neurosurgery 29:712–718PubMedCrossRefGoogle Scholar
  23. 23.
    Itoh Y, Yamada M (1997) Cerebral amyloid angiopathy in the elderly: the clinicopathological features, pathogenesis, and risk factors. J Med Dent Sci 44:11–19PubMedGoogle Scholar
  24. 24.
    Mehndiratta P, Manjila S, Ostergard T, Eisele S, Cohen ML, Sila C, Selman WR (2012) Cerebral amyloid angiopathy-associated intracerebral hemorrhage: pathology and management. Neurosurg Focus 32(4):E7PubMedCrossRefGoogle Scholar
  25. 25.
    Yamada M (2011) Cerebral amyloid angiopathy: pathogenesis and clinical features. Clin Neurol 51(11):1142Google Scholar
  26. 26.
    Pezzini A, Del ZE, Volonghi I, Giossi A, Costa P, Padovani A (2009) Cerebral amyloid angiopathy: a common cause of cerebral hemorrhage. Curr Med Chem 16:2498–2513PubMedCrossRefGoogle Scholar
  27. 27.
    Ritter MA, Droste DW, Hegedus K, Szepesi R, Nabavi DG, Csiba L, Ringelstein EB (2005) Role of cerebral amyloid angiopathy in intracerebral hemorrhage in hypertensive patients. Neurology 64(7):1233–1237PubMedCrossRefGoogle Scholar
  28. 28.
    Philipp TM, Sabine H, Florian A, Christof R, Ursula S, Peter R, Wolfang AW, Michael H (2011) Dural-biomarker imaging of regional cerebral amyloid load and neuronal activity in dementia with PET and 11C-labeled Pittsburgh Compound B. J Nucl Med 52(3):393–400CrossRefGoogle Scholar
  29. 29.
    Johnson KA, Gregas M, Becker J, Kinnecom C, Salat DH, Moran EK, Smith EE, Rosand J, Rentz DM, Klunk WE, Mathis CA, Price JC, DeKosky ST, Fischman AJ, Greenberg SM (2007) Imaging of amyloid burden and distribution in cerebral amyloid angiopathy. Ann Neurol 62:229–234PubMedCrossRefGoogle Scholar
  30. 30.
    Tucker WS, Bilbao JM, Klodawsky H (1980) Cerebral amyloid angiopathy and multiple intracerebral hematomas. Neurosurgery 7:611–614PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ya-juan Tang
    • 1
  • Yong Li
    • 3
  • Shuo Wang
    • 1
  • Ming-wei Zhu
    • 2
  • Yi-lin Sun
    • 4
  • Ji-zong Zhao
    • 1
  1. 1.Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
  2. 2.Department of Geriatric NeurologyChinese PLA General HospitalBeijingChina
  3. 3.Department of Neurosurgery, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
  4. 4.Department of UltropathologyBeijing Neurosurgical InstituteBeijingChina

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