Imaging Features in Cerebral Amyloid Angiopathy (original) (raw)
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Insights into Imaging, 2014
Objectives Sporadic cerebral amyloid angiopathy (CAA) is common cause of cerebrovascular disorders that predominantly affect elderly patients. When symptomatic, cortical-subcortical intracerebral haemorrhage (ICH) in the elderly is the most well-known manifestation of CAA. Furthermore, the clinical presentation varies from a sudden neurological deficit to seizures, transient symptoms and acute progressive cognitive decline. Despite its clinical importance, this multifaceted nature poses a diagnostic challenge for radiologists. The aims of this study were to expound the characteristics of neuroimaging modalities, which cover a wide spectrum of CAA-related imaging findings, and to review the various abnormal findings for which CAA could be responsible. Conclusions Radiologically, in addition to typical ICH, CAA leads to various types of abnormal findings, including microbleed, subarachnoid haemorrhage, superficial siderosis, microinfarction, reversible oedema, and irreversible leukoaraiosis. Taking into consideration the clinical importance of CAA-related disorders such as haemorrhagic risks and treatable oedema, it is necessary for radiologists to understand the wide spectrum of CAA-related imaging findings. Teaching Points • To describe the characteristics of imaging modalities and findings of CAA-related disorders. • MRI, especially gradient echo sequences, provides the useful information of CAA-related haemosiderin depositions. • To understand the wide spectrum of CAA-related neuroimaging and clinical features is important.
Teaching NeuroImage: Cerebral Amyloid Angiopathy–Related Inflammation
Neurology
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The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice
Journal of neurology, neurosurgery, and psychiatry, 2017
Cerebral amyloid angiopathy (CAA) has never been more relevant. The last 5 years have seen a rapid increase in publications and research in the field, with the development of new biomarkers for the disease, thanks to advances in MRI, amyloid positron emission tomography and cerebrospinal fluid biomarker analysis. The inadvertent development of CAA-like pathology in patients treated with amyloid-beta immunotherapy for Alzheimer's disease has highlighted the importance of establishing how and why CAA develops; without this information, the use of these treatments may be unnecessarily restricted. Our understanding of the clinical and radiological spectrum of CAA has continued to evolve, and there are new insights into the independent impact that CAA has on cognition in the context of ageing and intracerebral haemorrhage, as well as in Alzheimer's and other dementias. While the association between CAA and lobar intracerebral haemorrhage (with its high recurrence risk) is now wel...
Stroke, 2022
Background: Limited data exist regarding the prevalence of clinical and neuroimaging manifestations among patients diagnosed with cerebral amyloid angiopathy (CAA). We sought to determine the prevalence of clinical phenotypes and radiological markers in patients with CAA. Methods: Systematic review and meta-analysis of studies including patients with CAA was conducted to primarily assess the prevalence of clinical phenotypes and neuroimaging markers as available in the included studies. Sensitivity analyses were performed based on the (1) retrospective or prospective study design and (2) probable or unspecified CAA status. We pooled the prevalence rates using random-effects models and assessed the heterogeneity using the Cochran Q and I 2 statistics. Results: We identified 12 prospective and 34 retrospective studies including 7159 patients with CAA. The pooled prevalence rates were cerebral microbleeds (52% [95% CI, 43%–60%]; I 2 =93%), cortical superficial siderosis (49% [95% CI, 3...
Diagnosis and Treatment of Cerebral Amyloid Angiopathy
Clinics in Geriatric Medicine, 1991
Amyloid deposits in the cerebral vasculature are associated with a spectrum of overlapping clinicopathologic conditions distinguished from each other by their clinical presentation and anatomical distribution of amyloid fibril^.^,^^ The systemic vasculature is spared. Cerebral amyloid angiopathy (CAA) is being increasingly diagnosed in the normotensive elderly with intracerebral hemorrhage5 and has also been found in normal aging, Alzheimer's disease, hereditary cerebral hemorrhage, cerebral infarction, arteriovenous malformations, radiation necrosis, progressive demyelination syndromes, chronic vasculitis, dementia pugilistica, hereditary ataxia, the Parkinson-dementia complex of Guam, and spongiform encephal~pathies.~,~ The epidemiologic study of CAA is limited because confirmation of the diagnosis requires the examination of brain tissue. Thus, data on the prevalence of CAA are biased towards hospital-and autopsy-based populations rather than community studies.28 The data are also affected by the age of the subjects, the severity of the disease present, the diligence with which amyloid is sought, the extent of sampling, and the staining methods used.g The prevalence of CAA in normal people increases with age.5,28,38,47,48 Some degree of CAA was found in 36% of 84 autopsied brains in people ranging from 60 to 97 years of age. An increased proportion of brains contained CAA in each successive decade: 5% in the seventh decade, 43% in the eighth, 46% in the ninth, and 57% in
Cerebral amyloid angiopathy: Review of clinico-radiological features and mimics
Journal of medical imaging and radiation oncology, 2018
Cerebral amyloid angiopathy (CAA) is an important cause of lobar intracerebral haemorrhage (ICH) in the elderly, but has other clinico-radiological manifestations. In the last two decades, certain magnetic resonance imaging (MRI) sequences, namely gradient-recalled echo imaging and the newer and more sensitive susceptibility-weighted imaging, have been utilised to detect susceptibility-sensitive lesions such as cerebral microbleeds and cortical superficial siderosis. These can be utilised sensitively and specifically by the Modified Boston Criteria to make a diagnosis of CAA without the need for 'gold-standard' histopathology from biopsy. However, recently, other promising MRI biomarkers of CAA have been described which may further increase precision of radiological diagnosis, namely chronic white matter ischaemia, cerebral microinfarcts and lobar lacunes, cortical atrophy, and increased dilated perivascular spaces in the centrum semiovale. However, the radiological manifest...
Cerebral amyloid angiopathy--a disease or age-related condition
2006
Cerebral amyloid angiopathy is characterized by deposition of amyloid in the walls of leptomeninged and cerebral blood vessels. Its most common form, sporadic CAA that results from deposition of beta-amyloid peptide, which is the subject of this short review, is present in virtually all cases of Alzheimer disease and is also common among non-demented subjects where its prevalence increases with age. Stroke due to massive cerebral lobar hemorrhage is the main clinical presentation of CAA, but transient neurologic symptoms due to microhemorrhages may also occur. CAA is also a risk factor for cerebral infarction and there is increasing evidence that CAA contributes to cognitive impairment in the elderly, usually in association with white matter abnormalities on imaging. Although the definitive diagnosis of CAA is neuropathologic, reliable diagnosis can be reached clinically, based on the occurrence of strictly lobar hemorrhages, particularly in the cortico-subcortical area when using g...
International Journal of Stroke, 2019
Rationale The Boston criteria are used worldwide for the in vivo diagnosis of cerebral amyloid angiopathy and are the basis for clinical decision-making and research in the field. Given substantial advances in cerebral amyloid angiopathy's clinical aspects and MRI biomarkers, we designed a multicenter study within the International cerebral amyloid angiopathy Association aimed at further validating the diagnostic accuracy of the Boston and potentially improving and updating them. Aim We aim to derive and validate an updated “version 2.0” of the Boston criteria across the spectrum of cerebral amyloid angiopathy-related presentations and MRI biomarkers. Sample size estimates Participating centers with suitable available data (see Methods) were identified from existing collaborations and an open invitation to the International Cerebral Amyloid Angiopathy Association emailing list. Our study sample will include: (1) a derivation cohort – Massachusetts General Hospital (MGH), Boston ...