Disease trajectory in cerebral amyloid angiopathy: a matter of time.

Cerebral amyloid angiopathy (CAA) is a significant contributor to cerebrovascular disease, characterized by the deposition of amyloid-beta in the walls of cerebral small arteries and capillaries. This communication presents a detailed long-term follow-up of a 75-year-old female patient diagnosed with possible CAA in 2016, who demonstrated various clinical and neuroradiological manifestations over an 11-year period. Initial assessments revealed a right prerolandic hyperdense spontaneous convexal subarachnoid hemorrhage (cSAH) and a small vessel disease pattern on MRI. Subsequent imaging highlighted the progression of leptomeningeal involvement and cortical superficial siderosis (cSS), culminating in a lobar intracerebral hemorrhage (ICH) in 2026. This example shows the complexity and variability of CAA progression, underscoring different phenotypes and disease trajectories associated with CAA, and advocating for a nuanced understanding of its natural history to enhance personalized management strategies.