Cerebral Amyloid Angiopathy Presenting as Massive Subarachnoid Haemorrhage: A Case Study and Review of Literature

Saitô, Satoshi; Ikeda, Yoshihiko; Ando, Daisuke; Carare, Roxana O.; Ishibashi‐Ueda, Hatsue; Ihara, Masafumi

doi:10.3389/fnagi.2020.538456

Cited by 2 publications

(4 citation statements)

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“…For example, it is possible that FLP represent severe parenchymal amyloid deposition, whereas SAE could relate to large volume ICH (with leakage into the subarachnoid space) or severe leptomeningeal CAA. [37][38][39] Moreover, there are 2 different pathologic CAA subtypes: type 1, which is associated with e4 and capillary CAA, and type 2 associated with e2 and CAA in larger vessels. 40 It is thus possible that FLP are a biomarker of more severe capillary CAA, leading to an increased probability of intracerebral bleeding dissecting into brain tissue.…”

Section: Discussionmentioning

confidence: 99%

APOE and Cerebral Small Vessel Disease Markers in Patients With Intracerebral Hemorrhage

et al. 2022

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Background and Objective:We investigated the associations between Apolipoprotein E (APOE) genotype, intracerebral haemorrhage (ICH) and neuroimaging markers of cerebral amyloid angiopathy (CAA).Methods:We included patients from a prospective, multi-centre UK observational cohort study of patients with ICH and representative UK population controls. First, we assessed association of APOE genotype with ICH (compared to controls without ICH). Second, among patients with ICH, we assessed the association of APOE status with haematoma location (lobar or deep) and brain computed tomography (CT) markers of CAA (finger like projections [FLP] and subarachnoid extension [SAE]).Results:We included 907 patients with ICH and 2636 controls. Mean age was 73.2 (12.4 SD) years for ICH cases vs. 69.6 (0.2 SD) for population controls; 50.3% of cases and 42.1% of controls were female. Compared to controls, APOE ε2 allele was associated with all (lobar and non-lobar) as well as lobar ICH on its own in the dominant model, i.e. any APOE ε2 allele (OR 1.38, 95%CI 1.13-1.7, p=0.002 and OR 1.50, 95%CI 1.1-2.04, p=0.01, respectively), but not deep ICH in an age-adjusted analyses (OR 1.26, 95%CI 0.97-1.63, p=0.08) compared to controls. In the cases only analysis, APOE ε4 allele was associated with lobar compared to deep ICH in an age-adjusted analyses (OR 1.56, 95%CI 1.1-2.2, p=0.01). When assessing CAA markers, APOE alleles were independently associated with FLP (ε4: OR 1.74, 95%CI 1.04-2.93, p=0.04 and ε2/ε4: 2.56, 95%CI 0.99-6.61, p=0.05). We did not find an association between APOE alleles and SAE.Discussion:We confirmed associations between APOE alleles and ICH including lobar ICH. Our analysis shows selective associations between APOE ε2 and ε4 alleles with FLP, a CT marker of CAA. Our findings suggest that different APOE alleles might have diverging influences on individual neuroimaging biomarkers of CAA-associated ICH.

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Section: Discussionmentioning

confidence: 99%

APOE and Cerebral Small Vessel Disease Markers in Patients With Intracerebral Hemorrhage

et al. 2022

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“…CAA induces smooth muscle cell degeneration, vessel wall thickening, luminal narrowing and concentric wall splitting, resulting in varying degrees of intracerebral hemorrhage (ICH) (Love et al, 2014). Lobar, but not deep, ICH is associated with CAA (Saito et al, 2020a). Finger-like projections and subarachnoid hemorrhage extension of lobar ICH, together with the ApoE4 genotype, are reliable diagnostic markers for CAA (Rodrigues et al, 2018;Renard et al, 2019) (Figure 1A).…”

Section: Caa Inducing Cerebrovascular Diseasementioning

confidence: 99%

“…CAA is likely clinically underdiagnosed, due to the various clinical presentations outside of lobar ICH (Sakai et al, 2019;Fakan et al, 2020). Subarachnoid hemorrhage (SAH), resulting from bleeding into the subarachnoid space, known as "convexity SAH" in the acute phase (Figures 1B-D) and "superficial siderosis" in the chronic phase, can be induced by CAA (Saito et al, 2020a). Most CAA-induced bleeding into the subarachnoid space is limited without the involvement of the adjoining brain parenchyma (Kumar et al, 2010).…”

Section: Caa Inducing Cerebrovascular Diseasementioning

confidence: 99%

“…Most CAA-induced bleeding into the subarachnoid space is limited without the involvement of the adjoining brain parenchyma (Kumar et al, 2010). Many convexity SAH are asymptomatic, though the risk of future intracranial hemorrhage and death of patients with CAA-convexity SAH is very high (Calviere et al, 2019;Saito et al, 2020a).…”

Section: Caa Inducing Cerebrovascular Diseasementioning

confidence: 99%

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Taxifolin: A Potential Therapeutic Agent for Cerebral Amyloid Angiopathy

et al. 2021

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Cerebral amyloid angiopathy (CAA) is characterized by the accumulation of β-amyloid (Aβ) in the walls of cerebral vessels, leading to complications such as intracerebral hemorrhage, convexity subarachnoid hemorrhage and cerebral microinfarcts. Patients with CAA-related intracerebral hemorrhage are more likely to develop dementia and strokes. Several pathological investigations have demonstrated that more than 90% of Alzheimer’s disease patients have concomitant CAA, suggesting common pathogenic mechanisms. Potential causes of CAA include impaired Aβ clearance from the brain through the intramural periarterial drainage (IPAD) system. Conversely, CAA causes restriction of IPAD, limiting clearance. Early intervention in CAA could thus prevent Alzheimer’s disease progression. Growing evidence has suggested Taxifolin (dihydroquercetin) could be used as an effective therapy for CAA. Taxifolin is a plant flavonoid, widely available as a health supplement product, which has been demonstrated to exhibit anti-oxidative and anti-inflammatory effects, and provide protection against advanced glycation end products and mitochondrial damage. It has also been shown to facilitate disassembly, prevent oligomer formation and increase clearance of Aβ in a mouse model of CAA. Disturbed cerebrovascular reactivity and spatial reference memory impairment in CAA are completely prevented by Taxifolin treatment. These results highlight the need for clinical trials on the efficacy and safety of Taxifolin in patients with CAA

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Cerebral Amyloid Angiopathy Presenting as Massive Subarachnoid Haemorrhage: A Case Study and Review of Literature

Cited by 2 publications

References 24 publications

APOE and Cerebral Small Vessel Disease Markers in Patients With Intracerebral Hemorrhage

APOE and Cerebral Small Vessel Disease Markers in Patients With Intracerebral Hemorrhage

Taxifolin: A Potential Therapeutic Agent for Cerebral Amyloid Angiopathy

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