Cerebral Proliferative Angiopathy Presenting as Subdural Hematoma: A Case Report and Systematic Literature Review

Hess, Ryan M.; Zhang, Jeff F.; Cappuzzo, Justin M; Bregy, Amadé; Levy, Elad I.

doi:10.1016/j.wneu.2022.05.096

Cited by 3 publications

(2 citation statements)

References 35 publications

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“…A total 554 abstracts were screened, 48 full texts were reviewed of which a final 19 studies were included. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] These included 31 cases of hemorrhage in CPA which are summarized in Table 1. Of note, rebleeding occurred in 12 (39%) cases.…”

Section: Resultsmentioning

confidence: 99%

“…1 Re-hemorrhage as reported by Lasjaunias was more common in CPA (4/6, 67%) than in classical AVMs (24/ 583, 4%). 1 Despite limited/no follow-up of several of the published cases of hemorrhage in CPA, 8,12,14,[16][17][18] 12/31 (39%) of published cases have had documented recurrent hemorrhages. [1][2][3]6,7,13,17 It should be noted that although CPA is generally considered a separate entity from AVM most cases rely on angiographic features rather than more definitive/ distinguishing features evident on histopathology; however given the management, which is often non-surgical, this is not surprising.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent Intraventricular Haemorrhage in Cerebral Proliferative Angiopathy – A Case Report and Review of the Literature

Gerstl

Bernstock

Kappel

et al. 2023

The Neurohospitalist

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Cerebral proliferative angiopathy (CPA) is an entity distinct from that of classical arteriovenous malformations. As such, few reports have considered the long-term follow-up of patients with hemorrhage in CPA. Accordingly, herein the authors present a case of recurrent hemorrhage in CPA with 32 years of follow-up and in so doing summarize the literature of hemorrhagic cases in CPA. A 19-year-old presented with focal awareness seizures and diagnostic work-up revealed a left hemispheric vascular lesion. The patient presented again with intracranial hemorrhage at ages 28, 43 and 51. Angioarchitectural workup revealed intermingled brain parenchyma between vascular spaces, absence of dominant feeders and a clear nidus consistent with CPA. The size and diffuse nature of the lesion deemed it inoperable. Given our case and review of the literature it is apparent that CPA has a high risk of re-hemorrhage in the rare event that hemorrhage does occur.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recurrent Intraventricular Haemorrhage in Cerebral Proliferative Angiopathy – A Case Report and Review of the Literature

Gerstl

Bernstock

Kappel

et al. 2023

The Neurohospitalist

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Presentation and management of cerebral proliferative angiopathy: a systematic review and meta-analysis on treatment outcomes

Palavani,

Mitre,

Almeida

et al. 2024

Neurosurg Rev

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Proliferative Angiopathy: A Systematic Review

Brown,

Lien,

Ehresman

et al. 2024

SVIN

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BACKGROUND First described over 4 decades ago as a diffuse form of arteriovenous malformation, cerebral proliferative angiopathy (CPA) is now categorized as a distinct vascular anomaly. Unlike arteriovenous malformation, which typically forms a well‐developed vascular nidus with feeder vessels and distinct venous outflow, CPA is the product of disorganized angiogenesis; thus, it lacks a true nidus. Its characteristic cycle of ischemia, angiogenesis, and aberrant perfusion can lead to abnormal blood flow patterns that characterize the disease. Treatment of CPA has historically relied on conservative management (antiepileptic drugs), and efforts to effectively manage this pathology have been hindered by an incomplete understanding of its natural history. METHODS A systematic search of 4 databases was performed. The following variables were extracted when present: study sample size, year of publication, age(s) of patient(s), sex, presenting signs and symptoms, neurological deficits (pre‐ and postoperative), type of intervention, average follow‐up time, and patient‐reported as well as functional outcomes at last follow‐up. RESULTS Following the search and screen, 48 studies reporting 105 CPA cases remained eligible for inclusion. These studies consisted of 41 case reports, 6 case series, and 1 retrospective cohort study. The most common modality used in treatment of CPA was conservative management (53.4%). The second most common treatment modality was endovascular embolization (36.9%). The least common treatment modality was gamma knife radiosurgery, which was used in only 2 patients. Eleven patients experienced intracranial hemorrhage as a complication of CPA; 10 of the 11 patients underwent decompressive craniectomy. Finally, revascularization surgery was reportedly used in 5 patients (4.9%). CONCLUSION Although there remains a dearth of studies reporting CPA, several clearly defined traits have been identified that characterize this pathology and distinguish it from arteriovenous malformation. Nonetheless, the verdict has not yet been reached regarding the effectiveness of surgical interventions.

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Cerebral Proliferative Angiopathy Presenting as Subdural Hematoma: A Case Report and Systematic Literature Review

Cited by 3 publications

References 35 publications

Recurrent Intraventricular Haemorrhage in Cerebral Proliferative Angiopathy – A Case Report and Review of the Literature

Recurrent Intraventricular Haemorrhage in Cerebral Proliferative Angiopathy – A Case Report and Review of the Literature

Presentation and management of cerebral proliferative angiopathy: a systematic review and meta-analysis on treatment outcomes

Proliferative Angiopathy: A Systematic Review

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