Coexisting Subdural Hematoma in Cerebral Amyloid Angiopathy: A Case Series

Background: Cerebral amyloid angiopathy (CAA) is a common cause of spontaneous intracerebral hemorrhage (ICH) in elderly individuals, and it is characterized by the deposition of amyloid β protein (Aß) in the walls of small-caliber cortical and leptomeningeal vessels. The diagnostic criteria for CAA highlight its association with spontaneous lobar hemorrhage, convexity subarachnoid hemorrhage (SAH), and cortical superficial siderosis but not with subdural hematoma (SDH). This article presents a three-patient case series of CAA who experienced a lobar ICH associated with an SDH, underscoring a potentially under-recognized correlation between an acute ICH and coexistent SDH. Case presentation: We present a case series of three patients in a single university medical center who experienced acute-onset lobar ICH with a concurrent SDH, treated with evacuation. Histopathological examination established the diagnosis of CAA in all three cases. This case series underscores a potentially under-recognized association between an acute ICH and coexistent SDH in the context of CAA. Conclusions: Considering our findings, we emphasize the possibility that SDH may be a more frequent manifestation of CAA than previously recognized. Therefore, patients with CAA who initially present with acute SDH may be underdiagnosed, consequently leading to delayed identification and missed opportunities for proper risk assessment and management.