ELSEVIER AMYLOID ANGIOPATHY-RELATED CEREBELLAR HEMORRHAGE Emmanuel Cuny*, M.D., Hugues Loiseau*, M.D., Janine Rivel* *, M.D., Claude Vital**, M.D., and Jean-Pierre Castel, M.D.* *Clinic University of Neurosurgery, H6pital Pellegrin, Bordeaux, France; * *Depatiment of Neuropathology, H6pital Pellegrin, Bordeaux, France Cuny E, LoiseauH, RiveiJ, Vital C, Caste1 J-P, Amyloid angiopathy- related cerebellar hemorrhage. SurgNeurol 199646:235-g. BACKGROUND The posterior fossa localization of amyloid angiopathy- related hemorrhage is very unusual. Less than 10 cases have been previously reported. Surgical management of amyloid angiopathy-related hemorrhage is the subject of controversy. RESULTS Typical aspects of amyloid angiopathy were found within the surgically removed biopsies of a 71-year-old nonhy- pertensive, nondemented woman suffering cerebellar hemorrhage. CONCLUSIONS Amyloid angiopathy-related hemorrhage could occur in the cerebellum, and diagnosis might be suspected when no past history of mental deterioration and/or arterial hypertension are present and when angiography rules out vascular malformation. Surgical management seems to have the same restricted indications as in other brain areas. KEY WORDS Cerebellar hemorrhage, amyloid angiopathy, pathology, surgery, treatment. C erebral amyloid angiopathy (AA) accounts for 5% to 10% of primary nontraumatic in- tracerebral hemorrhage in elderly patients [ 17,191. AA-related intracranial hemorrhages tend to be confined to the cerebral hemispheres, cerebellar localizations being extremely rare. Identification of cerebral AA as a distinct disease, rather than an isolated neuropathologic marker, is a matter of de- bate because in a large percentage of the reported cases of hemorrhage, there was attendant dementia and/or arterial hypertension. Occurrence of AA- related cerebellar hemorrhage would constitute Address reprint requests to: Hugues Lolseau, M.D., Clinic University of Neurosurgery, HGpital Pellegrin, Place Am&lie Raba L&on, 33076 Bordeaux, France. Received December 5, 199% accepted February 14, 1996. @ 1996 by Efsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 strong evidence for a clear nosologic individualiza- tion of this disease. Surgical management of this type of hemorrhage is controversial. We report a new case of AA-related cerebellar hemorrhage in a nonhypertensive patient. CASEREPORT A 71-year-old Caucasian woman was admitted into emergency unit on March 1, 1994, for sudden oc- cipital headaches associated with vomiting and dizziness. No historic or physical indications of ar- terial hypertension, cardiovascular disease, hemor- rhagic diathesis, or intellectual deterioration were documented. Initial examination showed a fully conscious pa- tient with a Glasgow Coma Score (GCS) at 15, a left cerebellar syndrome, and a slight dilation of the right pupil. Her blood pressure was 180/100 mm Hg. A noninfused computed tomography (CT) scan disclosed a right cerebellar hemorrhage with a slight mass effect in the fourth ventricle (Figure 1). Electrocardiogram and biologic analysis were unre- markable. Chest X rays showed no cardiomegaly. Four hours later, her clinical situation rapidly deteriorated with clouding of consciousness (GCS at 13, then 9). A new CT scan showed no rebleeding, but there was ventricular enlargement. An external ventricular catheter was inserted into the right frontal horn and the cerebrospinal fluid drained (&cm water pressure). In spite of hydrocephalus treatment, the clinical situation continued to deteriorate with a GCS at 6. The patient was then intubated, ventilated, and neu- rosedated. Right vertebral angiography ruled out a vascular malformation. Emergency left occipital craniectomy was done 8 hours after admission. No subarachnoid hemorrhage (SAH) was observed. 009&3019/96/$15.00 PI1 s009c-3019(96)0015E-9