Cerebral amyloid angiopathy in spontaneous intracerebral hemorrhage - radiology and immunohistochemistry in a consecutive surgical series.

Introduction: Cerebral amyloid angiopathy (CAA) is a major cause of spontaneous intracerebral hemorrhage (ICH) in elderly patients and is associated with a high risk of recurrent hemorrhagic events. Research question: Whether the likelihood of CAA can be estimated using radiological criteria such as the Edinburgh criteria. Material and methods: We conducted a retrospective analysis of consecutive patients with spontaneous ICH who underwent neurosurgical hematoma evacuation between 01/2023 and 02/2025. Baseline clinical characteristics, radiological findings, and histopathological evaluations were assessed. Patients were classified as CAA-positive or CAA-negative based on immunohistochemical staining for amyloid-β deposition from intraoperative biopsies. Results: 53 patients met the inclusion criteria and CAA-positive patients were significantly older (76.9 vs. 65.4 years, Discussion and conclusions: Histopathologically confirmed CAA is associated with distinct radiological features, including ICH volume, irregular ICH borders and concurrent subarachnoid hemorrhage. Our findings highlight the importance of integrating histopathological analysis to improve diagnostic accuracy, as radiological criteria alone could not definitivey diagnose CAA in all patients.