Sporadic cerebral amyloid angiopathy: An important cause of cerebral hemorrhage in the elderly

ABSTRACTCerebral amyloid angiopathy (CAA) is an important cause of primary intracerebral hemorrhage (PICH) in the elderly. Although there are no pathognomic clinical features of CAA-related PICH, the association of white matter changes with lobar, recurrent, or multiple simultaneous hemorrhages in older patients should raise the suspicion of its diagnosis. A defi nitive diagnosis of CAA requires pathologic examination of the aff ected tissue. However, with modern imaging techniques, it is possible to diagnose the “probable CAA” in patients presenting with PICH. Gradient-echo magnetic resonance imaging is a very sensitive, noninvasive technique for identifying microhemorrhages in life. The diagnosis of CAA is important because of the likely implication it has on future management targeted to reduce risk of future bleeding.

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Infant critical head injury could be a remote cause of middle-aged cerebral amyloid angiopathy

10.21203/rs.2.422/v1 ◽

2019 ◽

Author(s):

Keisuke Tachiyama ◽

Masahiro Nakamori ◽

Yuki Hayashi ◽

Hayato Matsushima ◽

Eiji Imamura ◽

...

Keyword(s):

Cerebral Amyloid Angiopathy ◽

The Elderly ◽

Amyloid Angiopathy ◽

Resonance Imaging ◽

Middle Aged ◽

Case Presentation ◽

Csf Analysis ◽

History Of ◽

Lobar Hemorrhage ◽

Cerebral Amyloid

Abstract Background Cerebral amyloid angiopathy (CAA) is a sporadic condition in the elderly and is associated with Alzheimer’s disease. The younger cases, however, may have a history of traumatic brain injury (TBI) during infancy. Case Presentation We present a case of a 37-year-old man who had cerebral lobar hemorrhage. Magnetic resonance imaging revealed several lobar microbleeds, which along with the asymptomatic, lobar hemorrhages increased every year. At the age of 40 years, he developed mild cognitive impairment. Cerebrospinal fluid (CSF) analysis revealed a markedly decreased level of amyloid β42. Moreover, he had a subdural hematoma during infancy. Thus, we diagnosed him with CAA, which was related to the TBI at infancy. Conclusion TBI at infancy can be a remote cause of middle-aged CAA and dementia. This was supported by the low Aβ42 level in the CSF analysis.

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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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Post-Mortem 7.0-Tesla Magnetic Resonance Imaging of the Hippocampus in Progressive Supranuclear Palsy with and without Cerebral Amyloid Angiopathy

NeuroSci ◽

10.3390/neurosci1020011 ◽

2020 ◽

Vol 1 (2) ◽

pp. 115-120

Author(s):

Jacques De Reuck ◽

Florent Auger ◽

Nicolas Durieux ◽

Claude-Alain Maurage ◽

Vincent Deramecourt ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Progressive Supranuclear Palsy ◽

Cerebral Amyloid Angiopathy ◽

Amyloid Angiopathy ◽

Post Mortem ◽

Resonance Imaging ◽

Cerebral Amyloid ◽

Magnetic Resonance Imaging Mri ◽

Neuropathological Examination

Introduction and Purpose: Cerebral amyloid angiopathy (CAA) can be observed in patients with progressive supranuclear palsy (PSP), though to a lesser degree than in Alzheimer’s disease. The present post-mortem 7.0-tesla magnetic resonance imaging (MRI) evaluates whether CAA has an influence on the degree of hippocampal atrophy (HA) and on the incidence of associated micro-infarcts (HMIs) and cortical micro-bleeds (HMBs). Material and Methods: Eight brains with PSP-CAA were compared to 20 PSP brains without CAA. In addition to the neuropathological examination, the hippocampus was evaluated on the most representative coronal section with T2 and T2*-weighted MRI sequences. The average degree of HA was determined in both groups. The incidence of HMIs and HMBs was also compared as well as the frequency of cortical micro-infarcts (CoMIs) and cortical micro-bleeds (CoMBs) in the hemispheric neocortex. Results: The neuropathological examination showed a higher incidence of lacunar infarcts in the PSP-CAA brains compared to the PSP ones. With magnetic resonance imaging (MRI), the severity of HA and the incidence of HMIs and HMBs was similar between both groups. Additionally, the frequency of CoMIs and CoMBs in the neocortex was comparable. Conclusions: The association of CAA in PSP brains has no influence on the degree of HA and on the incidence of the small cerebrovascular lesions in the hippocampus as well as in the neocortex.

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Cerebral amyloid angiopathy severity is linked to dilation of juxtacortical perivascular spaces

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x15620434 ◽

2015 ◽

Vol 36 (3) ◽

pp. 576-580 ◽

Cited By ~ 33

Author(s):

Susanne J van Veluw ◽

Geert Jan Biessels ◽

Willem H Bouvy ◽

Wim GM Spliet ◽

Jaco JM Zwanenburg ◽

...

Keyword(s):

Cerebral Amyloid Angiopathy ◽

Small Vessel Disease ◽

Amyloid Β ◽

Amyloid Angiopathy ◽

Perivascular Spaces ◽

Resonance Imaging ◽

Centrum Semiovale ◽

Tissue Sections ◽

Cortical Areas ◽

Cerebral Amyloid

Perivascular spaces are an emerging marker of small vessel disease. Perivascular spaces in the centrum semiovale have been associated with cerebral amyloid angiopathy. However, a direct topographical relationship between dilated perivascular spaces and cerebral amyloid angiopathy severity has not been established. We examined this association using post-mortem magnetic resonance imaging in five cases with evidence of cerebral amyloid angiopathy pathology. Juxtacortical perivascular spaces dilation was evaluated on T2 images and related to cerebral amyloid angiopathy severity in overlying cortical areas on 34 tissue sections stained for Amyloid β. Degree of perivascular spaces dilation was significantly associated with cerebral amyloid angiopathy severity (odds ratio = 3.3, 95% confidence interval 1.3–7.9, p = 0.011). Thus, dilated juxtacortical perivascular spaces are a promising neuroimaging marker of cerebral amyloid angiopathy severity.

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Cortical Microinfarcts on 3T Magnetic Resonance Imaging in Cerebral Amyloid Angiopathy

Stroke ◽

10.1161/strokeaha.118.020810 ◽

2018 ◽

Vol 49 (8) ◽

pp. 1899-1905 ◽

Cited By ~ 7

Author(s):

Hilde van den Brink ◽

Angela Zwiers ◽

Aaron R. Switzer ◽

Anna Charlton ◽

Cheryl R. McCreary ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cerebral Amyloid Angiopathy ◽

Amyloid Angiopathy ◽

Resonance Imaging ◽

Cerebral Amyloid

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Advances in cerebral amyloid angiopathy imaging

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286419844113 ◽

2019 ◽

Vol 12 ◽

pp. 175628641984411 ◽

Cited By ~ 2

Author(s):

Szu-Ju Chen ◽

Hsin-Hsi Tsai ◽

Li-Kai Tsai ◽

Sung-Chun Tang ◽

Bo-Chin Lee ◽

...

Keyword(s):

Cerebral Amyloid Angiopathy ◽

Small Vessel Disease ◽

Imaging Techniques ◽

White Matter Hyperintensity ◽

Superficial Siderosis ◽

Clinical Aspects ◽

Amyloid Angiopathy ◽

Perivascular Spaces ◽

Imaging Studies ◽

Cerebral Amyloid

Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease caused by β -amyloid (Aβ) deposition at the leptomeningeal vessel walls. It is a common cause of spontaneous intracerebral hemorrhage and a frequent comorbidity in Alzheimer’s disease. The high recurrent hemorrhage rate in CAA makes it very important to recognize this disease to avoid potential harmful medication. Imaging studies play an important role in diagnosis and research of CAA. Conventional computed tomography and magnetic resonance imaging (MRI) methods reveal anatomical alterations, and remains as the most reliable tool in identifying CAA according to modified Boston criteria. The vascular injuries of CAA result in both hemorrhagic and ischemic manifestations and related structural changes on MRI, including cerebral microbleeds, cortical superficial siderosis, white matter hyperintensity, MRI-visible perivascular spaces, and cortical microinfarcts. As imaging techniques advance, not only does the resolution of conventional imaging improve, but novel skills in functional and molecular imaging studies also enable in vivo analysis of vessel physiological changes and underlying pathology. These modern tools help in early detection of CAA and may potentially serve as sensitive outcome markers in future clinical trials. In this article, we reviewed past studies of CAA focusing on utilization of various conventional and novel imaging techniques in both research and clinical aspects.

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Hypertension-Related Cerebral Microbleeds

Case Reports in Neurology ◽

10.1159/000508760 ◽

2020 ◽

Vol 12 (3) ◽

pp. 266-269

Author(s):

Sujan T. Reddy ◽

Sean I. Savitz

Keyword(s):

Magnetic Resonance Imaging ◽

Cerebral Microbleeds ◽

Chronic Hypertension ◽

Amyloid Angiopathy ◽

Resonance Imaging ◽

Gradient Echo ◽

Cerebellar Hemorrhage ◽

Common Causes ◽

Cerebral Amyloid ◽

The Brain

Hypertension and cerebral amyloid angiopathy are the most common causes of cerebral microbleeds. The pattern of microbleeds on T2*-weighted gradient echo sequence of magnetic resonance imaging of the brain can be indicative of the etiology of intracerebral hemorrhage. We describe a case of cerebellar hemorrhage with cerebral microbleeds secondary to chronic hypertension.

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