Update on Amyloid-associated Intracerebral Haemorrhage

Cerebral congophilic or amyloid angiopathy (CAA) is a clinicopathological entity that is considered a common cause of primary non-traumatic brain haemorrhage in the elderly. CAA is frequently associated with Alzheimer’s disease (AD) and has become a primary focus of scientific inquiry. The spectrum of intracerebral haemorrhage (ICH) that may occur in CAA includes: cerebral lobar haemorrhages, deep haemorrhages, purely subarachnoid and subdural haemorrhages and cerebral microbleeds. CAA is also associated with microinfarcts, leukoencephalopathy and superficial siderosis. This brief article will provide an update on the advances in our understanding of CAA-associated ICH with a focus on the following topics: neuropathology and mechanism of CAA-related haemorrhage; epidemiology, including genetic and other possible risk factors; clinical presentation; diagnosis, including newer imaging modalities; and prospects for prevention and treatment.

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Update on Amyloid-associated Intracerebral Hemorrhage

US Neurology ◽

10.17925/usn.2012.08.01.20 ◽

2012 ◽

Vol 08 (01) ◽

pp. 20

Author(s):

Rebbeca Grysiewicz ◽

Philip B Gorelick ◽

◽

Keyword(s):

Intracerebral Hemorrhage ◽

Scientific Inquiry ◽

Clinical Presentation ◽

The Elderly ◽

Superficial Siderosis ◽

Amyloid Angiopathy ◽

Common Cause ◽

Prevention And Treatment ◽

Subdural Hemorrhages ◽

Primary Focus

Cerebral congophilic or amyloid angiopathy (CAA) is a clinicopathological entity that is considered a common cause of primary non-traumatic brain hemorrhage in the elderly. CAA is frequently associated with Alzheimers disease (AD) and has become a primary focus of scientific inquiry. The spectrum of intracerebral hemorrhage (ICH) that may occur in CAA includes: cerebral lobar hemorrhages, deep hemorrhages, purely subarachnoid and subdural hemorrhages and cerebral microbleeds. CAA is also associated with microinfarcts, leukoencephalopathy and superficial siderosis. This brief article will provide an update on the advances in our understanding of CAA-associated ICH with a focus on the following topics: neuropathology and mechanism of CAA-related hemorrhage; epidemiology, including genetic and other possible risk factors; clinical presentation; diagnosis, including newer imaging modalities; and prospects for prevention and treatment.

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Abstract 2491: Cerebral Amyloid Angiopathy without Hemorrhagic Stroke: MRI Findings Associated with Transient Focal Symptoms

Stroke ◽

10.1161/str.43.suppl_1.a2491 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Jenelle A Jindal ◽

Alison M Ayres ◽

Mahmut E Gurol ◽

Kristin Schwab ◽

Jonathan Rosand ◽

...

Keyword(s):

Cerebral Amyloid Angiopathy ◽

Hemorrhagic Stroke ◽

Clinical Presentation ◽

Clinical Symptoms ◽

Massachusetts General Hospital ◽

The Other ◽

Superficial Siderosis ◽

Amyloid Angiopathy ◽

Neurologic Symptoms ◽

Cerebral Amyloid

Background: The clinical presentation of cerebral amyloid angiopathy (CAA) includes not only hemorrhagic stroke, but also diverse syndromes such as transient focal neurologic symptoms, progressive cognitive dysfunction, subacute confusion, and seizures. We performed a systematic analysis of the neuroimaging features of these presentations to help elucidate their underlying pathophysiologies. Methods: We performed a retrospective review of all patients seen at Massachusetts General Hospital from 2000-2011 with 1) diagnosis of probable/definite CAA by Boston criteria, 2) clinical presentation other than hemorrhagic stroke, and 3) available MR images (including T2*-weighted, diffusion-weighted, and FLAIR). Review of clinical data for 44 subjects meeting these criteria (performed blinded to neuroimaging) yielded 3 categories of presentation: transient focal motor, sensory, or language symptoms (n=15; mean±SD age 74.4±8.1), memory/cognitive impairment over months-years (n=15; age 71.2±10.7), and subacute headache, confusion, generalized seizure, or syncope (n=14; age 73.6±9.8). Images were analyzed without knowledge of clinical symptoms for hemorrhagic lesions, acute infarcts, and regional T2-hyperintensities. Results: Superficial siderosis in cortical sulci (Panel A) was present in 10 of 15 (67%) patients presenting with transient focal symptoms versus 7 of 29 (24%) in the other subgroups (p<0.01). Most locations of superficial siderosis corresponded with the localization of the patient’s transient symptoms. Conversely, a pattern of T2-hyperintensities extending to subcortical white matter and overlying cortex (Panel B) was present in 8 of 14 (57%) patients presenting with headache, confusion, or seizure/syncope versus 3 of 30 (10%) in the other subgroups (p<0.005). Conclusions: These results suggest that the underlying trigger for CAA-related transient focal neurologic symptoms may often be superficial siderosis. They also support an association between the alternative presentation of headache, confusion, or seizure/syncope and T2-hyperintensities suggestive of the inflammatory subtype of CAA.

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Effect Of Nhexane Extract Of Caryota No Seed On Markers Of Neurodegeneration And Fecundity In Drosophila Melanogaster

Gerontology & Geriatric Medicine ◽

10.24966/ggm-8662/100073 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1-7

Author(s):

Chinonye A Maduagwuna ◽

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Drosophila Melanogaster ◽

Neurodegenerative Diseases ◽

Cognitive Functions ◽

The Elderly ◽

Common Cause ◽

Chronic Neuroinflammation

Study background: Chronic neuroinflammation is a common emerging hallmark of several neurodegenerative diseases. Alzheimer’s Disease (AD) is the most common cause of dementia among the elderly and is characterized by loss of memory and other cognitive functions.

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ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

Wiadomości Lekarskie ◽

10.36740/wlek201908109 ◽

2019 ◽

Vol 72 (8) ◽

pp. 1466-1472

Author(s):

Grażyna Kobus ◽

Jolanta Małyszko ◽

Hanna Bachórzewska-Gajewska

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Acute Renal Failure ◽

Elderly Patients ◽

Older Patients ◽

Age Groups ◽

Kidney Injury ◽

The Elderly ◽

Younger Patients ◽

Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

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Secondary Normal-Pressure Hydrocephalus in Rheumatoid Meningitis

Case Reports in Neurology ◽

10.1159/000514728 ◽

2021 ◽

pp. 434-440

Author(s):

Micaela Owens ◽

Na Tosha Gatson ◽

Gino Mongelluzzo ◽

Oded Goren ◽

Eric Newman ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Normal Pressure Hydrocephalus ◽

Immune Suppression ◽

Normal Pressure ◽

The Elderly ◽

Common Cause ◽

Gait Abnormality ◽

Ventriculoperitoneal Shunting ◽

Patient Reported ◽

Rheumatoid Meningitis

Normal-pressure hydrocephalus (NPH) is a common cause of gait apraxia, cognitive impairment, and urinary incontinence in the elderly. It is usually a primary idiopathic disorder but can be secondary. We present a case of secondary NPH due to biopsy-confirmed rheumatoid meningitis initially refractory to intravenous (IV) immunotherapy. Our patient reported an excellent response right after shunting. Her gait remains normal one and a half years later. We searched PubMed for similar cases of rheumatoid meningitis with gait abnormality for additional clinicopathologic discussion. The patient’s movement disorder initially improved with steroid taper. However, she developed progressive symptoms, later on, refractory to IV solumedrol and rituximab. She underwent ventriculoperitoneal shunting (VPS) and reported an outstanding outcome. This is the first reported biopsy-confirmed case of rheumatoid meningitis causing NPH to undergo shunting for immediate improvement. Previous cases of rheumatoid meningitis-associated Parkinsonism have improved with steroid induction. Although our patient’s rheumatoid arthritis is now controlled, her case illustrates that NPH in autoinflammatory conditions may not recover with immune suppression alone. VPS is an option for a faster response in secondary NPH due to rheumatoid meningitis or other inflammatory disorders with progressive symptoms despite standard induction therapy.

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10-Year Follow-Up of a Patient with Cerebral Amyloid Angiopathy

Case Reports in Neurology ◽

10.1159/000501199 ◽

2020 ◽

Vol 12 (Suppl. 1) ◽

pp. 202-206

Author(s):

Min Kyoung Kang ◽

Byung-Woo Yoon

Keyword(s):

Cerebral Amyloid Angiopathy ◽

The Elderly ◽

Amyloid Angiopathy ◽

Spontaneous Intracerebral Hemorrhage ◽

Radiological Features ◽

Magnetic Imaging ◽

Long Term Follow Up ◽

Cerebral Amyloid

We report the case of long-term follow-up of brain magnetic imaging of cerebral amyloid angiopathy. Cerebral amyloid angiopathy is often considered a major cause of spontaneous intracerebral hemorrhage in the elderly. This case illustrates the markedly progressive clinical and radiological features of the vasculopathic process in 10 years.

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651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.845 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S383-S384

Author(s):

Fatma Hammami ◽

Makram Koubaa ◽

Amal Chakroun ◽

Fatma Smaoui ◽

Khaoula Rekik ◽

...

Keyword(s):

Otitis Externa ◽

Clinical Presentation ◽

The Elderly ◽

Causative Organism ◽

Diabetic Patients ◽

Duration Of Treatment ◽

Evolutionary Features ◽

Significant Difference ◽

Malignant Otitis Externa ◽

History Of

Abstract Background Malignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa. Methods We conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018. Results Overall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p< 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p< 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03). Conclusion Our study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment. Disclosures All Authors: No reported disclosures

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