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Cerebral amyloid angiopathy — MRCPsych Paper A MCQ

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ModerateNeuropathologyCerebral amyloid angiopathyMRCPsych Paper A

An 84-year-old woman has progressive cognitive decline and two spontaneous intracerebral haemorrhages in different lobar locations. Susceptibility-weighted MRI shows multiple strictly lobar cerebral microbleeds and cortical superficial siderosis, with no deep haemorrhagic lesions. Which neuropathological finding best explains this pattern?

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Correct answer: C — Amyloid-beta deposition in cortical and leptomeningeal vessel walls

The correct answer is C. Cerebral amyloid angiopathy is caused by amyloid-beta deposition within cortical and leptomeningeal vessel walls. The resulting vessel fragility produces recurrent lobar haemorrhages, strictly lobar microbleeds and cortical superficial siderosis, and it may contribute to cognitive decline. Lipohyalinosis predominantly affects deep perforating arterioles and is associated with deep haemorrhages in structures such as the basal ganglia, thalamus and pons. Granulomatous cerebral vasculitis more often causes multifocal ischaemic or inflammatory manifestations rather than this characteristic haemorrhagic distribution. Fibrinoid necrosis is associated with severe or malignant hypertension. Pick bodies are intraneuronal tau inclusions found in frontotemporal lobar degeneration and do not explain recurrent lobar haemorrhage.

Reference: Sellimi A, Schwartze J, Humphries F, et al. Contemporary perspectives in cerebral amyloid angiopathy. Expert Review of Neurotherapeutics. 2025;25(8):887-910. https://pubmed.ncbi.nlm.nih.gov/40619804/