An old man accompanied by his son came to the outpatient clinic for a checkup. The son said that the old man had a brain hemorrhage in the past, with slurred speech, slow reaction time, difficulty in moving around, and difficulty in taking care of himself, and that this time he came to the clinic for a routine checkup without any new symptoms. There was no history of hypertension, hyperlipidemia, diabetes, smoking or alcoholism. As they did not bring any information with them, the doctor arranged for a nuclear magnetic scan of the head and blood tests. But when the results of the MRI came out, the son was dumbfounded. The report read: multiple lobar hemorrhages, located in the left frontal lobe and right occipital lobe. When asked, the old man said that there was nothing difficult, no headache, vomiting, hemiplegia, dizziness, and other symptoms that are often associated with cerebral hemorrhage. At this point, we highly suspected that the old man was suffering from a disease called “cerebrovascular amyloidosis”, and his son asked in confusion, “Starch? Starch in the brain?” “No, it’s not that kind of starch, it’s an amyloid substance.” So what does “starch” mean here? Is there starch in the brain? Of course not. Cerebrovascular amyloidosis is a disease of unknown etiology, most commonly seen in the elderly, due to a large number of amyloid-like protein deposits in the cerebral blood vessels, causing localized degeneration and necrosis of the blood vessels, rupture caused by cerebral hemorrhage. The blood flows out of the blood vessels and destroys the surrounding brain tissues, which can cause hemiparesis, speech difficulties, headaches, seizures and other manifestations. Large amounts of bleeding can lead to coma and death, or there can be no obvious symptoms if the bleeding is small. If a small amount of brain tissue is surgically removed and stained for pathology, the abnormal material appears under the microscope as a pink color similar to the coloring of starch. The so-called “starch” in the brain is, of course, nothing like the starch we eat every day. An MRI or CT scan of the skull shows that the hemorrhage is mainly close to or under the cortex, unlike the deep hemorrhages caused by high blood pressure. Special sequences of cranial MRI, such as SWI and GRE sequences, can show multiple ferritin deposits in the brain, which is highly suggestive of cerebrovascular amyloidosis. During the hospitalization of the elderly man above, the cognitive function assessment showed that he was in a state of dementia, and the SWI showed that the cerebral cortex had multiple ferruginous deposits, so we highly suspected cerebrovascular amyloidosis. You may ask, why can’t we confirm the diagnosis? A definitive diagnosis requires a surgical brain biopsy or postmortem autopsy! Once the disease has developed, there is an average annual recurrence rate of 10%, which means that after the first attack, there may be multiple recurrences. Is there a way to prevent recurrence? Unfortunately, there are no proven preventive measures that have a definite effect, but some medical experts’ opinions can be taken into account: blood pressure should be monitored to ensure that it does not become too high and cause bleeding to worsen, and controlling blood pressure may also reduce the recurrence of cerebral hemorrhage; patients should refrain from anticoagulant and antiplatelet medications, such as warfarin and aspirin, and should not receive blood-thinning treatments; and it has been reported that oral painkillers may increase recurrence of brain hemorrhage in patients with this disease. Cerebral hemorrhage recurrence in patients with the disease, so if necessary, you should first discuss with your own doctor whether it can be used. From the above, it can be seen that cerebrovascular amyloidosis is a special kind of cerebrovascular disease, which is completely different from the usual cerebral infarction and cerebral hemorrhage related to high blood pressure, diabetes, and smoking. With the improvement of examination methods and diagnostic level, the diagnostic rate of cerebrovascular amyloidosis has increased significantly in the past 10 years or so, and this kind of patient is not uncommon now, and we should all be more vigilant.