Atypical presentation of cerebral amyloid angiopathy in a 42-year-old man with recurrent lobar hemorrhages and neuropsychiatric symptoms

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Background: Cerebral amyloid angiopathy (CAA) is a small- and medium-vessel cerebrovascular disease characterized by β-amyloid accumulation within cortical and leptomeningeal arterial walls. Although it most commonly manifests in older individuals as spontaneous lobar hemorrhage, uncommon cases have been reported in younger patients, especially those with risk factors such as previous head trauma, genetic predisposition, or prior exposure to cadaveric dura. Case Description: We describe a diagnostically challenging case of suspected CAA in a 42-year-old man with a history of multiple traumatic brain injuries, prior neurosurgical interventions, neuropsychiatric symptoms, and late-onset seizures. Importantly, during treatment for head trauma in early adulthood, he received a cadaveric dura transplant. Over subsequent years, he developed recurrent lobar hemorrhages and progressive cognitive and behavioral changes, raising concern for an atypical, possibly iatrogenic, form of CAA. Conclusion: This case highlights the need to consider CAA - even in younger patients - when recurrent lobar hemorrhages and neuropsychiatric symptoms occur in the context of relevant risk factors such as previous head trauma or cadaveric dura exposure. We believe that such exposure may underlie this patient's gradual but persistent neurological and cognitive decline.

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