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October 28, 1983

Bleeding Manifestations in Patients With Amyloidosis

Author Affiliations

Veterans Administration Medical Center Long Beach, Calif

JAMA. 1983;250(16):2110. doi:10.1001/jama.1983.03340160014014

To the Editor.—  Yood and colleagues, in a recent article in The Journal (1983;249:1322), suggest that bleeding problems in patients with amyloidosis are probably more closely related to increased fragility of amyloid-infiltrated blood vessels than to abnormal coagulation. We would like to add, in support of their suggestion, that a localized form of amyloidosis within the CNS, cerebral amyloid angiopathy (CAA), is also associated with a bleeding tendency, apparently as a result of structural alterations in vessel walls. Cerebral amyloid angiopathy typically occurs in localized fashion within the brains of nonhypertensive elderly subjects and is characterized clinically by dementia and recurrent episodes of intracerebral hemorrhage.1-3 The distribution of lesions correlates closely with sites of amyloid deposition within the brain, namely, small leptomeningeal and superficial cortical arteries and veins. The sharp localization of microscopic hemorrhages of varying age that we and others2 have observed around vessels heavily infiltrated by