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Martín-Jiménez P, Sánchez-Tornero M, Llamas-Velasco S, Guerrero-Molina MP, González-Sánchez M, Herrero-San Martín A, Blanco-Palmero V, Calleja-Castaño P, Francisco-Gonzalo J, Hilario A, Ramos A, Salvador E, Toldos Ó, Hernández-Lain A, Pérez-Martínez DA, Villarejo-Galende A. Cerebral amyloid angiopathy-related inflammation: clinical features and treatment response in a case series. Neurologia 2023; 38:550-559. [PMID: 37437655 DOI: 10.1016/j.nrleng.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/31/2020] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to β-amyloid deposition in the walls of cerebral microvessels. METHODS We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.
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Affiliation(s)
- P Martín-Jiménez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - M Sánchez-Tornero
- Servicio de Neurofisiología, Hospital Universitario La Paz, Madrid, Spain
| | - S Llamas-Velasco
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | - M González-Sánchez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - A Herrero-San Martín
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - V Blanco-Palmero
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - P Calleja-Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - A Hilario
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Ramos
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Salvador
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ó Toldos
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Hernández-Lain
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D A Pérez-Martínez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - A Villarejo-Galende
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain
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Martín-Jiménez P, Sánchez-Tornero M, Llamas-Velasco S, Guerrero-Molina MP, González-Sánchez M, Herrero-San Martín A, Blanco-Palmero V, Calleja-Castaño P, Francisco-Gonzalo J, Hilario A, Ramos A, Salvador E, Toldos Ó, Hernández-Lain A, Pérez-Martínez DA, Villarejo-Galende A. Cerebral amyloid angiopathy-related inflammation: clinical features and treatment response in a case series. Neurologia 2021; 38:S0213-4853(21)00033-5. [PMID: 33726968 DOI: 10.1016/j.nrl.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an entity characterised by an inflammatory response to β-amyloid deposition in the walls of cerebral microvessels. METHODS We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria. RESULTS The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed. CONCLUSIONS Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.
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Affiliation(s)
- P Martín-Jiménez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - M Sánchez-Tornero
- Servicio de Neurofisiología, Hospital Universitario La Paz, Madrid, España
| | - S Llamas-Velasco
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - M P Guerrero-Molina
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
| | - M González-Sánchez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - A Herrero-San Martín
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - V Blanco-Palmero
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - P Calleja-Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Francisco-Gonzalo
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Hilario
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Ramos
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Salvador
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - Ó Toldos
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Hernández-Lain
- Servicio de Anatomía Patológica, Sección de Neuropatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - D A Pérez-Martínez
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España
| | - A Villarejo-Galende
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Grupo de Enfermedades Neurodegenerativas, Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, España; Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España
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Galiano Blancart RF, Fortea G, Pampliega Pérez A, Martí S, Parkhutik V, Sánchez Cruz AV, Soriano C, Geffner Sclarsky D, Pérez Saldaña MT, López Hernández N, Beltrán I, Lago Martín A. One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: A prospective series of 34 patients. Neurologia 2018; 36:215-221. [PMID: 29903393 DOI: 10.1016/j.nrl.2017.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/16/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis. METHODS We performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia. RESULTS The study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH. CONCLUSIONS The most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment.
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Affiliation(s)
| | - G Fortea
- Servicio de Neurología, Hospital La Fe, Valencia, España
| | - A Pampliega Pérez
- Servicio de Neurología, Hospital General de Alicante, Alicante, España
| | - S Martí
- Servicio de Neurología, Hospital General de Alicante, Alicante, España
| | - V Parkhutik
- Servicio de Neurología, Hospital La Fe, Valencia, España
| | | | - C Soriano
- Servicio de Neurología, Hospital General de Castellón, Castelló de la Plana, España
| | - D Geffner Sclarsky
- Servicio de Neurología, Hospital General de Castellón, Castelló de la Plana, España
| | | | - N López Hernández
- Servicio de Neurología, Hospital General de Alicante, Alicante, España
| | - I Beltrán
- Servicio de Neurología, Hospital General de Alicante, Alicante, España
| | - A Lago Martín
- Servicio de Neurología, Hospital La Fe, Valencia, España
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