1
|
Ikeda M, Okamoto K, Suzuki K, Takai E, Kasahara H, Furuta N, Furuta M, Tashiro Y, Shimizu C, Takatama S, Naito I, Sato M, Sakai Y, Takahashi M, Amari M, Takatama M, Higuchi T, Tsushima Y, Yokoo H, Kurabayashi M, Ishibashi S, Ishii K, Ikeda Y. Recurrent Lobar Hemorrhages and Multiple Cortical Superficial Siderosis in a Patient of Alzheimer's Disease With Homozygous APOE ε2 Allele Presenting Hypobetalipoproteinemia and Pathological Findings of 18F-THK5351 Positron Emission Tomography: A Case Report. Front Neurol 2021; 12:645625. [PMID: 34305778 PMCID: PMC8294698 DOI: 10.3389/fneur.2021.645625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
In Alzheimer's disease, the apolipoprotein E gene (APOE) ε2 allele is a protective genetic factor, whereas the APOE ε4 allele is a genetic risk factor. However, both the APOE ε2 and the APOE ε4 alleles are genetic risk factors for lobar intracerebral hemorrhage. The reasons for the high prevalence of lobar intracerebral hemorrhage and the low prevalence of Alzheimer's disease with the APOE ε2 allele remains unknown. Here, we describe the case of a 79-year-old Japanese female with Alzheimer's disease, homozygous for the APOE ε2 allele. This patient presented with recurrent lobar hemorrhages and multiple cortical superficial siderosis. The findings on the 11C-labeled Pittsburgh Compound B-positron emission tomography (PET) were characteristic of Alzheimer's disease. 18F-THK5351 PET revealed that the accumulation of 18F-THK 5351 in the right pyramidal tract at the pontine level, the cerebral peduncle of the midbrain, and the internal capsule, reflecting the lesions of the previous lobar intracerebral hemorrhage in the right frontal lobe. Moreover, 18F-THK5351 accumulated in the bilateral globus pallidum, amygdala, caudate nuclei, and the substantia nigra of the midbrain, which were probably off-target reaction, by binding to monoamine oxidase B (MAO-B). 18F-THK5351 were also detected in the periphery of prior lobar hemorrhages and a cortical subarachnoid hemorrhage, as well as in some, but not all, areas affected by cortical siderosis. Besides, 18F-THK5351 retentions were observed in the bilateral medial temporal cortices and several cortical areas without cerebral amyloid angiopathy or prior hemorrhages, possibly where tau might accumulate. This is the first report of a patient with Alzheimer's disease, carrying homozygous APOE ε2 allele and presenting with recurrent lobar hemorrhages, multiple cortical superficial siderosis, and immunohistochemically vascular amyloid β. The 18F-THK5351 PET findings suggested MAO-B concentrated regions, astroglial activation, Waller degeneration of the pyramidal tract, neuroinflammation due to CAA related hemorrhages, and possible tau accumulation.
Collapse
Affiliation(s)
- Masaki Ikeda
- Division of General Education (Neurology), Faculty of Health & Medical Care, Saitama Medical University, Saitama, Japan.,Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan.,Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Koichi Okamoto
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Keiji Suzuki
- Department of Pathology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Eriko Takai
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroo Kasahara
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Natsumi Furuta
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Minori Furuta
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuichi Tashiro
- Department of Neurology, Mito Medical Center, Mito, Japan
| | - Chisato Shimizu
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Shin Takatama
- Department of Neurosurgery, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Isao Naito
- Department of Neurosurgery, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Mie Sato
- Department of Anesthesiology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Yasujiro Sakai
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Manabu Takahashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masakuni Amari
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Masamitsu Takatama
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideaki Yokoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Masahiko Kurabayashi
- Department of Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Kenji Ishii
- Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|
2
|
Ikeda M, Kodaira S, Kasahara H, Takai E, Nagashima K, Fujita Y, Makioka K, Hirayanagi K, Furuta N, Furuta M, Sanada E, Kobayashi A, Harigaya Y, Nagamine S, Hattori N, Tashiro Y, Kishi K, Shimada H, Suto T, Tanaka H, Sakai Y, Yamazaki T, Tanaka Y, Aihara Y, Amari M, Yamaguchi H, Okamoto K, Takatama M, Ishii K, Higuchi T, Tsushima Y, Ikeda Y. Cerebral Microbleeds, Cerebrospinal Fluid, and Neuroimaging Markers in Clinical Subtypes of Alzheimer's Disease. Front Neurol 2021; 12:543866. [PMID: 33889121 PMCID: PMC8056016 DOI: 10.3389/fneur.2021.543866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Lobar cerebral microbleeds (CMBs) in Alzheimer's disease (AD) are associated with cerebral amyloid angiopathy (CAA) due to vascular amyloid beta (Aβ) deposits. However, the relationship between lobar CMBs and clinical subtypes of AD remains unknown. Here, we enrolled patients with early- and late-onset amnestic dominant AD, logopenic variant of primary progressive aphasia (lvPPA) and posterior cortical atrophy (PCA) who were compatible with the AD criteria. We then examined the levels of cerebrospinal fluid (CSF) biomarkers [Aβ1-42, Aβ1-40, Aβ1-38, phosphorylated tau 181 (P-Tau), total tau (T-Tau), neurofilament light chain (NFL), and chitinase 3-like 1 protein (YKL-40)], analyzed the number and localization of CMBs, and measured the cerebral blood flow (CBF) volume by 99mTc-ethyl cysteinate dimer single photon emission computerized tomography (99mTc ECD-SPECT), as well as the mean cortical standard uptake value ratio by 11C-labeled Pittsburgh Compound B-positron emission tomography (11C PiB-PET). Lobar CMBs in lvPPA were distributed in the temporal, frontal, and parietal lobes with the left side predominance, while the CBF volume in lvPPA significantly decreased in the left temporal area, where the number of lobar CMBs and the CBF volumes showed a significant inversely correlation. The CSF levels of NFL in lvPPA were significantly higher compared to the other AD subtypes and non-demented subjects. The numbers of lobar CMBs significantly increased the CSF levels of NFL in the total AD patients, additionally, among AD subtypes, the CSF levels of NFL in lvPPA predominantly were higher by increasing number of lobar CMBs. On the other hand, the CSF levels of Aβ1-38, Aβ1-40, Aβ1-42, P-Tau, and T-Tau were lower by increasing number of lobar CMBs in the total AD patients. These findings may suggest that aberrant brain hypoperfusion in lvPPA was derived from the brain atrophy due to neurodegeneration, and possibly may involve the aberrant microcirculation causing by lobar CMBs and cerebrovascular injuries, with the left side dominance, consequently leading to a clinical phenotype of logopenic variant.
Collapse
Affiliation(s)
- Masaki Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan.,Division of Common Education (Neurology), Faculty of Health and Medical Care, Saitama Medical University, Hidaka, Japan
| | - Sayaka Kodaira
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroo Kasahara
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Eriko Takai
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuaki Nagashima
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukio Fujita
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kouki Makioka
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kimitoshi Hirayanagi
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Natsumi Furuta
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Minori Furuta
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Etsuko Sanada
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ayumi Kobayashi
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yasuo Harigaya
- Department of Neurology, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Shun Nagamine
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Noriaki Hattori
- Department of Neuropsychiatry, Jomo Hospital, Maebashi, Japan
| | - Yuichi Tashiro
- Department of Neurology, Mito Medical Center, Mito, Japan
| | - Kazuhiro Kishi
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Hirotaka Shimada
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Takayuki Suto
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Hisashi Tanaka
- Department of Neuropsychiatry, Tanaka Hospital, Yoshioka, Japan
| | - Yasujiro Sakai
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Tsuneo Yamazaki
- Department of Occupational Therapy, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Yukiko Tanaka
- Department of Geriatric Medicine, Uchida Hospital, Numata, Japan
| | - Yuko Aihara
- Department of Neurology, Shinozuka Hospital, Fujioka, Japan
| | - Masakuni Amari
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Haruyasu Yamaguchi
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan.,Tokyo Center for Dementia Research and Practices, Tokyo, Japan
| | - Koichi Okamoto
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Masamitsu Takatama
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Kenji Ishii
- Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| |
Collapse
|