Cerebral Amyloid Angiopathy in the Elderly

Tomonaga, Masanori

doi:10.1111/j.1532-5415.1981.tb01757.x

Cited by 146 publications

(68 citation statements)

References 11 publications

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“…413 One patient in this series had a history of ischemic stroke, an association that has been reported previously. 6 -81315 ' 26 Most (seven) of the nine patients with ICH in this series were women, a finding that has been reported by others 413 but not substantiated from compiled series of patients. 5 Also, autopsy studies 813 ' 26 -27 have not shown a sex predilection for CAA.…”

Section: Discussionsupporting

confidence: 68%

Surgical experience with cerebral amyloid angiopathy.

Greene

Godersky

Biller

et al. 1990

Stroke

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Cerebral amyloid angiopathy can present as lobar intracerebral hemorrhage in an elderly person, presumably due to increased fragility of the vessels affected by amyloid deposition. For this reason, patients presenting with intracerebral hemorrhage and suspected of having cerebral amyloid angiopathy have often been treated nonsurgically. Since 1983 we have evaluated 11 patients with cerebral amyloid angiopathy (nine women and two men, mean age 73 years) who have undergone either intracerebral hematoma evacuation or brain biopsy. Nine of the 11 patients presented with intracerebral hemorrhage, which was unilobar in three patients and multilobar in six and involved the parietal lobes seven times, the frontal lobes four times, the temporal lobes four times, and the occipital lobes twice. These nine patients underwent hematoma removal, with no cases of abnormal intraoperative bleeding or recurrent hemorrhage. Six patients improved neurologically, and two were unchanged after hematoma evacuation; the remaining patient had a fatal cardiopulmonary arrest during the immediate postoperative period. During follow-up in seven patients (median 11 months, range 1 week to 74 months) none experienced a recurrent intracerebral hemorrhage and four continued to improve. Two of the 11 patients had cerebral amyloid angiopathy diagnosed by brain biopsy as part of an evaluation for dementia, also without surgical complications. This series suggests that patients with cerebral amyloid angiopathy may safely undergo operative procedures, and patients presenting with intracerebral hemorrhage may show neurologic improvement following evacuation of the hematoma.

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Section: Discussionsupporting

confidence: 68%

Surgical experience with cerebral amyloid angiopathy.

Greene

Godersky

Biller

et al. 1990

Stroke

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“…Furthermore, these subcortical ICHs have shown, in some series, a predilection for the posterior aspects of the cerebral hemispheres, reflecting a generally heavier concentration of CAA-affected arteries in the parietal and occipital lobes. 6 ' 13 In some instances, subarachnoid or subdural hemorrhages have coexisted, again reflecting the superficial location of the vascular lesions. An additional feature of ICH related to CAA has been a tendency to produce recurrent hemorrhages over periods of months or years, 14 occasionally even leading to simultaneous acute intracerebral hematomas in two different brain locations.…”

Section: Cerebral Amyloid Angiopathymentioning

confidence: 99%

“…With very few exceptions, 13 this factor is considered to be a consistent feature in most hemorrhagic complications in orally anticoagulated patients. ICH is no exception to this rule: fully 80% of patients with ICH have excessively prolonged prothrombin times (PT) at the onset of hemorrhage.…”

mentioning

confidence: 99%

Intracerebral hemorrhage: non-hypertensive causes.

Kase¹

1986

Stroke

111

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SPONTANEOUS, non-traumatic intracerebral hemorrhage (ICH) in the adult is most commonly secondary to hypertensive cerebrovascular disease. In 70-90% of cases of spontaneous ICH, arterial hypertension is the presumed cause.1 These hypertensive hemorrhages show a predilection for certain anatomic locations: the basal ganglia (the putamen in particular), the subcortical white matter, and the thalamus account for 35%, 25%, and 20% of ICHs, respectively, whereas the posterior fossa locations, the cerebellum and pons, are responsible for only 10% and 5% of the cases.2 Irrespective of their anatomic locations, the common pathogenesis in these hemorrhages involves the hypertension-induced degeneration of the media of small (50-200 micra) arteries called "lypo-hyalinosis," 3 and/ or the formation of "microaneurysms", both of which occur preferentially in perforating or small sub-cortical arteries, thus resulting in the characteristic anatomic distribution of hypertensive ICH.A significant number of cases of ICH are due to causes other than hypertension. The frequency of such cases varies from 25% to 50% among series, and depends on the anatomic type of ICH being considered: non-hypertensive mechanisms may account for as many as 55% of "lobar" ICH cases, 4 ' 3 while pontine hemorrhage is virtually always (90%) hypertensive, and the deep ganglionic (putaminal, thalamic) and cerebellar varieties occupy an intermediate position (35%, 25%, and 38% being of non-hypertensive mechanism, respectively). Among the many possible mechanisms of ICH not primarily related to hypertension, there are several that occur with high enough frequency to warrant separate discussion. These causes of ICH are related to special types of arterial pathology, to the presence of brain tumors, or to the use of medications, and include: cerebral amyloid angiopathy, small vascular malformations, primary or metastatic brain tumors, oral anticoagulants, and amphetamines and a variety of other sympathomimetic drugs. Cerebral Amyloid AngiopathyThis condition is a unique form of angiopathy due to deposits of amyloid in the media and adventitia of

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“…4,5 The proposed mechanism mediating this clinical effect is vascular dysfunction and resulting ischemic brain injury for CAA (Figure 2). 9,[16][17][18] The relatively high prevalence of CAA (36% in autopsy series) 19 and moderatesevere arteriolosclerosis (40%) in the elderly 20 make these conditions ideal models to study disease mechanisms for VCI. Not surprisingly, most of the molecular neuroimaging studies in VCI were performed in such cohorts.…”

Section: Gurol Molecular Neuroimaging In Vascular Dementia 1147mentioning

confidence: 99%

Molecular Neuroimaging in Vascular Cognitive Impairment

Gurol

2016

Stroke

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Cerebral Amyloid Angiopathy in the Elderly

Cited by 146 publications

References 11 publications

Surgical experience with cerebral amyloid angiopathy.

Surgical experience with cerebral amyloid angiopathy.

Intracerebral hemorrhage: non-hypertensive causes.

Molecular Neuroimaging in Vascular Cognitive Impairment

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