White matter hyper-intensity patterns in patients with amyloid angiopathy

Background: Pathological changes in the cerebral white matter can be determined both in small vessel disease and in cerebral amyloid angiopathy. The pattern of involvement may be different depending on the etiology and severity of the process. Objective of the study: Determination and analysis of the pattern of cerebral white matter changes in patients with amyloid angiopathy and involvement of the cerebellum.

Material and methods: Patients with intracerebral hemorrhages who were examined by magnetic resonance imaging were prospectively analyzed. Patients were diagnosed with cerebral amyloid angiopathy (CAA) according to Boston criteria. Changes in white matter were interpreted using the Fazekas scale and compared for patients with CAA and patients with CAA and cerebellar involvement. Of the 614 patients with intracerebral hemorrhage, 96 were examined by cerebral magnetic resonance imaging. Of these, 41 patients were diagnosed with amyloid angiopathy, 19 patients with possible amyloid angiopathy, 21 patients – probable and 1 case with defined amyloid angiopathy.

Results:  Cerebellar involvement was determined in 34% (14/41) of cases. Severe changes in white matter (Fazekas 2-3) were seen in patients with cerebellar involvement (12/14; 86% versus 8/27 and 30% p = 0.002). 

Conclusions: Involvement of the white matter in the pathological process is more significant in patients with amyloid angiopathy and the involvement of the cerebellum, even after adjusting for risk factors. Patients with cerebellar haemorrhage and severe white matter should be screened for amyloid angiopathy.