Background: There are sporadic case reports of amyloid angiopathy presenting as subarachnoid haemorrhage (SAH). In previous case reports, the prognosis appears to be relatively benign. We have encountered three such cases where the prognoses are less benign. The clinical, imaging and biopsy features will be described below.
Method: A retrospective of patients who presented to Monash Medical Centre with convexity SAH and no evidence of intracranial aneurysm.
Results: The three patients present with multiple transient sensory symptoms that are similar to the marching symptoms in migrainous attacks. Only one of the three had accompanying headache. All patients underwent CT, MRI and MR angiography and two of the three patients had CT angiography. Patient 1 was clinically labelled as having transient ischemic attack, patient 2 as having migraine and patient 3 has having focal seizure. All patients developed lobar haemorrhage within 1 to 26 months of the initials presentation. Brain biopsy in patients (1 and 2) revealed typical changes of amyloid angiopathy. Patient 1 developed features of dementia 30 months after the initial presentation and was commenced on Donepezil.
Conclusion: Convexity SAH may be the presenting feature of amyloid angiopathy and is likely to be followed by lobar haemorrhage. Recognition of these features can lead to avoidance of antiplatelet and anticoagulation therapy.