Unilateral cerebral amyloid angiopathy after neurointervention

Romero, A. Lázaro; Loscertales, C Moreno; Moreno, Eugenia Marta

doi:10.1016/j.nrleng.2021.05.009

Cited by 4 publications

(10 citation statements)

References 13 publications

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“…Compared to previously published data, 1,2,5–7,14–27 our cohort has a higher average age, with most patients presenting in their late 40s. These results may reflect an increased awareness of iCAA diagnosis among clinicians, especially regarding older patients, following the publication of the QSC.…”

Section: Discussioncontrasting

confidence: 64%

“…In addition, relevant exposure occurred 5 years later (11 years compared to 6 years) than reported in earlier studies. 1,2,[5][6][7][14][15][16][17][18][19][20][21][22][23][24][25][26][27] We also observed slightly longer latency in our cohort compared to previous data (38 vs 35 years). 1,2,5-7,14-27 International Journal of Stroke, 19 (3) Exposure to cadaveric dura material with available printed documentation was somewhat lower in our cohort compared to previously reported cases (30% vs 44%).…”

Section: Discussionsupporting

confidence: 50%

“…After applying our search strategy, we found 6 new reports 5–7,14–16 describing cases of patients with iCAA in addition to those 13 articles already summarized in Banerjee et al 4 (Supplemental Figure 1). Fifty-seven patients were investigated for possible associations between biomarkers and temporal dynamics of iCAA (Supplemental Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…4 Most previously published cases with iCAA had undergone neurosurgical intervention in childhood or pre-adolescence, coming to clinical attention primarily due to intracerebral hemorrhage at an age atypical for CAA, and thus stimulating attention by physicians. 1,2,[5][6][7][14][15][16][17][18][19][20][21][22][23][24][25][26][27] This ascertainment bias may have resulted in selection bias so far, causing only patients with young disease onset to be investigated for iCAA. Indeed, we found a somewhat delayed time to diagnosis in older patients compared to those under and equal to age of 55.…”

Section: Discussionmentioning

confidence: 99%

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Iatrogenic cerebral amyloid angiopathy: A multinational case series and individual patient data analysis of the literature

Pikija,

Pretnar-Oblak,

Frol

et al. 2023

International Journal of Stroke

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Background: The transmission of amyloid β (Aβ) in humans leading to iatrogenic cerebral amyloid angiopathy (iCAA) is a novel concept with analogies to prion diseases. However, the number of published cases is low, and larger international studies are missing. Aims: We aimed to build a large multinational collaboration on iCAA to better understand the clinical spectrum of affected patients. Methods: We collected clinical data on patients with iCAA from Austria, Croatia, Italy, Slovenia, and Spain. Patients were included if they met the proposed Queen Square diagnostic criteria (QSC) for iCAA. In addition, we pooled data on disease onset, latency, and cerebrospinal fluid (CSF) biomarkers from previously published iCAA cases based on a systematic literature review. Results: Twenty-seven patients (22% women) were included in this study. Of these, 19 (70%) met the criteria for probable and 8 (30%) for possible iCAA. Prior neurosurgical procedures were performed in all patients (93% brain surgery, 7% spinal surgery) at median age of 8 (interquartile range (IQR) = 4–18, range = 0–26 years) years. The median symptom latency was 39 years (IQR = 34–41, range = 28–49). The median age at symptom onset was 49 years (IQR = 43–55, range = 32–70). Twenty-one patients (78%) presented with intracranial hemorrhage and 3 (11%) with seizures. Conclusions: Our large international case series of patients with iCAA confirms a wide age boundary for the diagnosis of iCAA. Dissemination of awareness of this rare condition will help to identify more affected patients.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionsupporting

confidence: 50%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Iatrogenic cerebral amyloid angiopathy: A multinational case series and individual patient data analysis of the literature

Pikija,

Pretnar-Oblak,

Frol

et al. 2023

International Journal of Stroke

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“…We identified 31 patients from the literature, of whom 20 (65%) were classified as probable iCAA (8 confirmed use of Lyodura) and 11 as possible iCAA (5 confirmed use of Lyodura). [5][6][7][11][12][13][14][19][20][21][22][23][24][25][26][27][28][29][30] Histopathology was available in 21/31 patients (20 brain biopsies and 1 postmortem examination) and confirmed the presence of CAA in all. Tau pathology was investigated in 6 and present in 3 (50%) patients.…”

Section: Previously Described Patients In the Literaturementioning

confidence: 98%

Iatrogenic Cerebral Amyloid Angiopathy Post Neurosurgery: Frequency, Clinical Profile, Radiological Features, and Outcome

Kaushik

Etten

Siegerink

et al. 2023

Stroke

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Background: Prion-like transmission of amyloid-ß through cadaveric dura, decades after neurosurgical procedures, has been hypothesized as an iatrogenic cause of cerebral amyloid angiopathy (CAA). We investigated new and previously described patients to assess the clinical profile, radiological features, and outcome of this presumed iatrogenic CAA-subtype (iCAA). Methods: Patients were collected from our prospective lobar hemorrhage and CAA database (n=251) with patients presenting to our hospital between 2008 and 2022. In addition, we identified patients with iCAA from 2 other Dutch CAA-expertise hospitals and performed a systematic literature-search for previously described patients. We classified patients according to the previously proposed diagnostic criteria for iCAA, assessed clinical and radiological disease features, and calculated intracerebral hemorrhage (ICH)-recurrence rates. We evaluated the spatial colocalization of cadaveric dura placement and CAA-associated magnetic resonance imaging markers. Results: We included 49 patients (74% men, mean age 43 years [range, 27–84]); 15 from our database (6% [95% CI, 3%–10%]; 45% of patients <55 years), 3 from the 2 other CAA-expertise hospitals, and 31 from the literature. We classified 43% (n=21; 1 newly identified patient) as probable and 57% (n=28) as possible iCAA. Patients presented with lobar ICH (57%), transient focal neurological episodes (12%), or seizures (8%). ICH-recurrence rate in the new patients (16/100 person-years [95% CI, 7–32], median follow-up 18 months) was lower than in the previously described patients (77/100 person-years [95% CI, 59–99], median follow-up 18 months). One patient had a 10 year interlude without ICH-recurrence. We identified no clear spatial relationship between dura placement and CAA-associated magnetic resonance imaging markers. During follow-up (median, 18 months), 20% of the patients developed transient focal neurological episodes and 20% cognitively declined. Conclusions: iCAA seems common in patients presenting with nonhereditary CAA under the age of 55. Clinical and radiological features are comparable with sCAA. After diagnosis, multiple ICH-recurrences but also long symptom-free intervals can occur. Harmonized registries are necessary to identify and understand this potentially underrecognized CAA-subtype.

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Spatial colocalization of imaging markers in iatrogenic cerebral amyloid angiopathy with the site of surgery: A metaanalysis

Jensen-Kondering

2024

Journal of the Neurological Sciences

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Unilateral cerebral amyloid angiopathy after neurointervention

Cited by 4 publications

References 13 publications

Iatrogenic cerebral amyloid angiopathy: A multinational case series and individual patient data analysis of the literature

Iatrogenic cerebral amyloid angiopathy: A multinational case series and individual patient data analysis of the literature

Iatrogenic Cerebral Amyloid Angiopathy Post Neurosurgery: Frequency, Clinical Profile, Radiological Features, and Outcome

Spatial colocalization of imaging markers in iatrogenic cerebral amyloid angiopathy with the site of surgery: A metaanalysis

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