Surgical experience with cerebral amyloid angiopathy.

Greene, George M.; Godersky, John C.; Biller, José; Hart, M. N.; Adams, Harold P.

doi:10.1161/01.str.21.11.1545

Cited by 54 publications

(22 citation statements)

References 24 publications

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“…14,19,24,29,36,56,113,119 The prevalence of hypertension in those patients is significantly lower than that found in the general population 65-74 years old. 52 In studies reporting estimated hematoma volume, the average volume was 57 cm 3 .…”

Section: Literature Review Of Surgical Case Seriesmentioning

confidence: 90%

“…14,35,41,78 However, since those early reports, there have been numerous surgical series reporting safe performance of hematoma evacuation and cortical biopsy (Table 4). 16,19,24,29,33,49,56,97 Many of these case series specifically state that the authors experienced no problems with intraoperative hemostasis. 29,49,56,68 The establishment of surgical safety in CAA is extremely important when discussing minimally invasive techniques where hemostasis can be more cumbersome to attain.…”

Section: Surgical Management Of Amyloid-associated Ichmentioning

confidence: 99%

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Cerebral amyloid angiopathy–associated intracerebral hemorrhage: pathology and management

Mehndiratta¹,

Manjila

Ostergard

et al. 2012

FOC

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Amyloid angiopathy–associated intracerebral hemorrhage (ICH) comprises 12%–15% of lobar ICH in the elderly. This growing population has an increasing incidence of thrombolysis-related hemorrhages, causing the management of hemorrhages associated with cerebral amyloid angiopathy (CAA) to take center stage. A concise reference assimilating the pathology and management of this clinical entity does not exist. Amyloid angiopathy–associated hemorrhages are most often solitary, but the natural history often progresses to include multifocal and recurrent hemorrhages. Compared with other causes of ICH, patients with CAA-associated hemorrhages have a lower mortality rate but an increased risk of recurrence. Unlike hypertensive arteriolar hemorrhages that occur in penetrating subcortical vessels, CAA-associated hemorrhages are superficial in location due to preferential involvement of vessels in the cerebral cortex and meninges. This feature makes CAA-associated hemorrhages easier to access surgically. In this paper, the authors discuss 3 postulates regarding the pathogenesis of amyloid hemorrhages, as well as the established clinicopathological classification of amyloid angiopathy and CAA-associated ICH. Common inheritance patterns of familial CAA with hemorrhagic strokes are discussed along with the role of genetic screening in relatives of patients with CAA. The radiological characteristics of CAA are described with specific attention to CAA-associated microhemorrhages. The detection of these microhemorrhages may have important clinical implications on the administration of anticoagulation and antiplatelet therapy in patients with probable CAA. Poor patient outcome in CAA-associated ICH is associated with dementia, increasing age, hematoma volume and location, initial Glasgow Coma Scale score, and intraventricular extension. The surgical management strategies for amyloid hemorrhages are discussed with a review of published surgical case series and their outcomes with a special attention to postoperative hemorrhage.

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Section: Literature Review Of Surgical Case Seriesmentioning

confidence: 90%

Section: Surgical Management Of Amyloid-associated Ichmentioning

confidence: 99%

Cerebral amyloid angiopathy–associated intracerebral hemorrhage: pathology and management

Mehndiratta¹,

Manjila

Ostergard

et al. 2012

FOC

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“…39,40 Several reports have also referred to the safety of the biopsy of the cerebral cortex in patients with CAA-ICH. [41][42][43][44] Mehndiratta et al reported that the probability of postoperative hemorrhage within the first 48 hours of surgery was 11.8% on average (the probability ranged from 0% to 22% among the previous reports), and the mortality rate was 24.4% on average (0%-75%) in patients with CAA-ICH. The patients' poor outcome in CAA-ICH with surgical intervention was estimated to be associated with poor preoperative functional status, age over 75 years, preoperative diagnosis of dementia, hematoma volume greater than 60 ml, the presence of IVH, and postoperative hemorrhage.…”

Section: Safety Of Craniotomy and Biopsy In Patients With Caa-ichmentioning

confidence: 98%

Clinico-Radiological Characteristics and Pathological Diagnosis of Cerebral Amyloid Angiopathy-Related Intracerebral Hemorrhage

Doden

Sato

Sasahara

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Objective: We aim to clarify the clinico-radiological characteristics of cerebral amyloid angiopathy-related intracerebral hemorrhage and to investigate the efficacy of pathological diagnosis using biopsy specimens. Method: We retrospectively reviewed 253 consecutive patients with cortico-subcortical hemorrhage who had been admitted to Aizawa Hospital between January 2006 and July 2013. We had performed craniotomy and hematoma evacuation in 48 patients, as well as biopsy of the evacuated hematoma, cerebral parenchyma adjacent to the hematoma, or both, and they were classified according to the histological results (positive or negative for vascular amyloid deposition) and to the Boston criteria. We compared the clinicoradiological characteristics of cerebral amyloid angiopathy-related intracerebral hemorrhage. We also investigated the detection rate of cerebral amyloid angiopathy with respect to the origins of the specimens. Results: Pathological examination revealed that 22 subjects were positive for vascular amyloid. The number of the cerebral microbleeds located in the deep or infratentorial region was significantly larger in the negative group than in the positive group (P < .05). There was no significant difference in the distribution of lobar cerebral microbleeds and in the prevalence of hypertension. In the probable cerebral amyloid angiopathyrelated intracerebral hemorrhage patients, the probability of having vascular amyloid detected by biopsy of both hematoma and parenchyma was 100%. Rebleeding in the postoperative periods was observed in 2 cases (9.1%) of the positive group.Conclusions: Our results demonstrate the importance and safety of biopsy simultaneously performed with hematoma evacuation. Deep or infratentorial microbleeds are less correlated with cerebral amyloid angiopathy-related intracerebral hemorrhage than with noncerebral amyloid angiopathy-related intracerebral hemorrhage.

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“…2 The clinical risk profile in CAAH has not, however, been firmly established. 5 Although previous reports of CAAH have included patients who were taking antiplatelet or anticoagulant medication, 6 -8 had suffered minor head trauma 9 or had hypertension, 10 it is unclear whether these clinical features are risk factors for CAAH that are independent of the effects of APOE genotype. In the present study we have established the frequency of these putative clinical risk factors in a large series of patients with a pathological diagnosis of CAAH and compared our findings with those in previous reports.…”

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confidence: 99%

Cerebral Amyloid Angiopathy–Related Hemorrhage

McCarron

Nicoll

Ironside

et al. 1999

Stroke

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Background and Purpose-Current evidence suggests that the apolipoprotein E (APOE for gene; apoE for protein) ⑀4 allele predisposes to cerebral amyloid angiopathy (CAA) whereas ⑀2 is associated with CAA-related hemorrhage (CAAH). The clinical risk factors for other forms of intracranial hemorrhage are a less-frequent feature of CAAH. In this study we examined potential clinical risk factors in patients with CAAH and assessed these with respect to APOE genotype. Methods-Thirty-six patients were identified with a pathological diagnosis of CAAH. Clinical notes were reviewed to document age of hemorrhage onset, history of dementia, antiplatelet/anticoagulant medication, hypertension, minor head trauma, or transient neurological events. In a review of reported cases of CAAH, the frequency of these clinical features was also recorded. APOE genotypes were determined with use of polymerase chain reaction techniques. Results-There were 24 women and 12 men; the mean age was 70.3 years. One third (nϭ12) had been taking antiplatelet medication, and a similar number were demented. Nine patients were hypertensive, and 4 had a history of recent minor head trauma. The relative frequency of each of these clinical features was similar to that in previous reports. Forty-four percent (16 of 36) possessed an ⑀2 allele. Antiplatelet or anticoagulant medication, hypertension, or minor head trauma were significantly more frequent antecedents of CAAH in ⑀2 carriers than in non-⑀2 carriers (81% versus 35%, Pϭ0.008), antiplatelet/anticoagulant medication in particular (Pϭ0.038). Conclusions-Our findings suggest that antiplatelet or anticoagulant medication, hypertension, or minor head trauma are most likely to precipitate cerebral hemorrhage in patients with CAA who are also ⑀2 carriers. This may result from isoform-specific effects of apoE on the structure of amyloid-laden blood vessel walls. (Stroke. 1999;30:1643-1646.)Key Words: apolipoproteins Ⅲ cerebral amyloid angiopathy Ⅲ intracerebral hemorrhage S poradic cerebral amyloid angiopathy (CAA) is characterized by the deposition of amyloid ␤-protein (A␤) in small to medium-sized leptomeningeal and cortical blood vessels. The incidence of CAA increases with age, 1 but the process usually remains asymptomatic. However, a minority of patients develop single or multiple CAA-related hemorrhages (CAAH). This observation prompted us to search for specific risk factors (genetic or environmental) that may precipitate hemorrhage from amyloid-laden vessels.Recent evidence implicates the apolipoprotein E gene (APOE) in the etiology of CAAH. 2,3 We previously hypothesized that whereas the APOE ⑀4 allele increases A␤ deposition in the cerebral vasculature, 4 APOE ⑀2 is associated with rupture of A␤-laden blood vessels, possibly by predisposing to the development of recognized vasculopathic complications of CAA. 2 The clinical risk profile in CAAH has not, however, been firmly established. 5 Although previous reports of CAAH have included patients who were taking antiplatelet or anticoagulant medicatio...

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Surgical experience with cerebral amyloid angiopathy.

Cited by 54 publications

References 24 publications

Cerebral amyloid angiopathy–associated intracerebral hemorrhage: pathology and management

Cerebral amyloid angiopathy–associated intracerebral hemorrhage: pathology and management

Clinico-Radiological Characteristics and Pathological Diagnosis of Cerebral Amyloid Angiopathy-Related Intracerebral Hemorrhage

Cerebral Amyloid Angiopathy–Related Hemorrhage

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