PMC7683384_01
Head CT showed right frontal lobe (arrows) and insula (arrowheads) intracerebral haemorrhage (ICH) adjacent to the brain surface. Blood was also noted in the subarachnoid space, spreading from the basal cistern to the bilateral Sylvian fissure with hydrocephalus and brain herniation.
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F1
Head CT showed right frontal lobe and insula ICH adjacent to the brain surface (Figure 1). Haematoma volume was estimated as 14.9 and 5.9 cm3, respectively (manual segmentation using OsiriX software: Pixmeo,
(A) Coronal section of the brain. ICH with subarachnoid haemorrhage (SAH) extension was observed in the right hemisphere. (B) Macroscopic image showing the cerebral vasculature. We did not find any evidence of saccular aneurysm in these vessels. The posterior communicating arteries were not identified. (C) Cerebrovascular immunostaining of Abeta (brown; M0872, DAKO, 1:50) with nuclear counterstain (blue). (D) Senile plaque with modified Bielschowsky staining. Scale bars indicate 2 cm (B) and 20 mum (C,D). ACA, anterior cerebral artery; BA, basilar artery; ICA, internal carotid artery; Lt, left; MCA, middle cerebral artery; PCA, posterior cerebral artery; Rt, right; VA, vertebral artery.
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F2
Bleeding into the subarachnoid space widely spread to the sulcus of the frontotemporal cortex in the right hemisphere, accompanied by an uncal and subfalcine hernia (Figure 2A). We did not find any aneurysm in the cerebral vasculature (Figure 2B). Histologically, abundant Abeta deposits were observed within the leptomeningeal and cortical arteries around the parenchymal haemorrhagic lesions (Figure 2C), which led to the pathological diagnoses of ICH related to CAA with SAH extension. Modified Bielschowsky staining uncovered senile plaques and neurofibrillary tangles (Figure 2D), which was compatible with the diagnosis of AD (Hyman et al.,); Abeta plaque score, A1 (Thal et al.,), neurofibrillary tangle stage, B2 (Braak and Braak,), neuritic plaque score, C3 (Mirra et al.,).