Spontaneous lobar intracerebral haemorrhage in a patient over about 55, especially without severe hypertension, should raise suspicion of cerebral amyloid angiopathy. MRI with susceptibility-weighted or gradient-echo sequences can show strictly lobar microbleeds or cortical superficial siderosis, which support the diagnosis under the Boston criteria. The diagnosis changes the risk of recurrence and weighs heavily in decisions about antithrombotic treatment.
- Lobar location and older age point towards amyloid angiopathy; deep bleeds point towards hypertensive arteriopathy.
- Request MRI with SWI or gradient-echo sequences after a lobar bleed.
- Cortical superficial siderosis signals higher recurrence risk.
- Factor the diagnosis into any later decision about anticoagulation or antiplatelets.
Why it matters
The cause of the first bleed shapes the risk of the next one and every antithrombotic decision after it.
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