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Pikija S, Pretnar-Oblak J, Frol S, Malojcic B, Gattringer T, Rak-Frattner K, Staykov D, Salmaggi A, Milani R, Magdic J, Iglseder S, Trinka E, Kraus T, Toma A, DiFrancesco JC, Tabaee Damavandi P, Fabin N, Bersano A, de la Riva Juez P, Albajar Gomez I, Storti B, Fandler-Höfler S. Iatrogenic cerebral amyloid angiopathy: A multinational case series and individual patient data analysis of the literature. Int J Stroke 2024; 19:314-321. [PMID: 37700397 DOI: 10.1177/17474930231203133] [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] [Indexed: 09/14/2023]
Abstract
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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Affiliation(s)
- Slaven Pikija
- Department of Neurology, Christian Doppler University Hospital, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Janja Pretnar-Oblak
- Department of Vascular Neurology, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Senta Frol
- Department of Vascular Neurology, Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Branko Malojcic
- Department of Neurology, Zagreb School of Medicine, University Hospital Center, Zagreb, Croatia
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Kinga Rak-Frattner
- Department of Neurology, Krankenhaus der Barmherzigen Brüder, Eisenstadt, Austria
| | - Dimitre Staykov
- Department of Neurology, Krankenhaus der Barmherzigen Brüder, Eisenstadt, Austria
| | - Andrea Salmaggi
- Department of Neurology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Riccardo Milani
- Department of Neurology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Jozef Magdic
- Division of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Sarah Iglseder
- Department of Vascular Neurology, University Medical Centre Innsbruck, Innsbruck, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
- Department of Public Health, Health Services Research, and Health Technology Assessment, Hall in Tirol, Austria
| | - Theo Kraus
- Department of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Andreea Toma
- Department of Neurology, Christian Doppler University Hospital, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Natalia Fabin
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Patricia de la Riva Juez
- Stroke Unit, Donostia University Hospital, Neurovascular Diseases, Biodonostia Institute, San Sebastián, Spain
| | - Ines Albajar Gomez
- Stroke Unit, Donostia University Hospital, Neurovascular Diseases, Biodonostia Institute, San Sebastián, Spain
| | - Benedetta Storti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Dargvainiene J, Jensen-Kondering U, Bender B, Berg D, Brüggemann N, Flüh C, Markewitz R, Neumann A, Röben B, Röcken C, Royl G, Schulte C, Wandinger KP, Weiler C, Margraf NG, Kuhlenbäumer G. Aβ38 and Aβ43 do not differentiate between Alzheimer's disease and cerebral amyloid angiopathy. Ann Clin Transl Neurol 2024; 11:806-811. [PMID: 38186185 DOI: 10.1002/acn3.51987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024] Open
Abstract
Differential diagnosis between Alzheimer's disease (AD) and cerebral amyloid angiopathy (CAA) using cerebrospinal fluid (CSF) biomarkers is challenging. A recent study suggested that the addition of Aβ38 and Aβ43 to a standard AD biomarker panel (Aβ40, Aβ42, t-tau, p-tau) to improve the differential diagnosis. We tested this hypothesis in an independent German cohort of CAA and AD patients and controls using the same analytical techniques. We found excellent discrimination between AD and controls and between CAA and controls, but not between AD and CAA. Adding Aβ38 and Aβ43 to the panel did not improve the discrimination between AD and CAA.
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Affiliation(s)
- Justina Dargvainiene
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulf Jensen-Kondering
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Benjamin Bender
- Department of Radiology, Diagnostical and Interventional Neuroradiology, University Hospital of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Norbert Brüggemann
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Robert Markewitz
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Alexander Neumann
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Benjamin Röben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Pathology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Georg Royl
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Klaus-Peter Wandinger
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Caroline Weiler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Nils G Margraf
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University (CAU), Kiel, Germany
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Li J, Wang X, Li Y, Gao Y, Luo H, Xu Y. Teaching NeuroImage: CADASIL Mimicking Cerebral Amyloid Angiopathy-Related Inflammation. Neurology 2024; 102:e209155. [PMID: 38290083 DOI: 10.1212/wnl.0000000000209155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/22/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Jiaqi Li
- From the Department of Neurology (J.L., Y.L., Y.G., H.L., Y.X.) and Department of Magnetic Resonance (X.W.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Wang
- From the Department of Neurology (J.L., Y.L., Y.G., H.L., Y.X.) and Department of Magnetic Resonance (X.W.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yapeng Li
- From the Department of Neurology (J.L., Y.L., Y.G., H.L., Y.X.) and Department of Magnetic Resonance (X.W.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Gao
- From the Department of Neurology (J.L., Y.L., Y.G., H.L., Y.X.) and Department of Magnetic Resonance (X.W.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haiyang Luo
- From the Department of Neurology (J.L., Y.L., Y.G., H.L., Y.X.) and Department of Magnetic Resonance (X.W.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuming Xu
- From the Department of Neurology (J.L., Y.L., Y.G., H.L., Y.X.) and Department of Magnetic Resonance (X.W.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Szalardy L, Fakan B, Maszlag-Torok R, Ferencz E, Reisz Z, Radics BL, Csizmadia S, Szpisjak L, Annus A, Zadori D, Kovacs GG, Klivenyi P. Identifying diagnostic and prognostic factors in cerebral amyloid angiopathy-related inflammation: A systematic analysis of published and seven new cases. Neuropathol Appl Neurobiol 2024; 50:e12946. [PMID: 38093468 DOI: 10.1111/nan.12946] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 11/02/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024]
Abstract
AIMS Cerebral amyloid angiopathy (CAA)-related inflammation (CAA-RI) is a potentially reversible manifestation of CAA, histopathologically characterised by transmural and/or perivascular inflammatory infiltrates. We aimed to identify clinical, radiological and laboratory variables capable of improving or supporting the diagnosis of or predicting/influencing the prognosis of CAA-RI and to retrospectively evaluate different therapeutic approaches. METHODS We present clinical and neuroradiological observations in seven unpublished CAA-RI cases, including neuropathological findings in two definite cases. These cases were included in a systematic analysis of probable/definite CAA-RI cases published in the literature up to 31 December 2021. Descriptive and associative analyses were performed, including a set of clinical, radiological and laboratory variables to predict short-term, 6-month and 1-year outcomes and mortality, first on definite and second on an expanded probable/definite CAA-RI cohort. RESULTS Data on 205 definite and 100 probable cases were analysed. CAA-RI had a younger symptomatic onset than non-inflammatory CAA, without sex preference. Transmural histology was more likely to be associated with the co-localisation of microbleeds with confluent white matter hyperintensities on magnetic resonance imaging (MRI). Incorporating leptomeningeal enhancement and/or sulcal non-nulling on fluid-attenuated inversion recovery (FLAIR) enhanced the sensitivity of the criteria. Cerebrospinal fluid pleocytosis was associated with a decreased probability of clinical improvement and longer term positive outcomes. Future lobar haemorrhage was associated with adverse outcomes, including mortality. Immunosuppression was associated with short-term improvement, with less clear effects on long-term outcomes. The superiority of high-dose over low-dose corticosteroids was not established. CONCLUSIONS This is the largest retrospective associative analysis of published CAA-RI cases and the first to include an expanded probable/definite cohort to identify diagnostic/prognostic markers. We propose points for further crystallisation of the criteria and directions for future prospective studies.
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Affiliation(s)
- Levente Szalardy
- Department of Neurology, Albert Szent-Györgyi Medical School, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Bernadett Fakan
- Department of Neurology, Albert Szent-Györgyi Medical School, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Rita Maszlag-Torok
- Department of Neurology, Albert Szent-Györgyi Medical School, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Emil Ferencz
- Department of Neurology, Albert Szent-Györgyi Medical School, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zita Reisz
- Institute of Pathology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
- Department of Clinical Neuropathology, King's College Hospital, London, UK
| | - Bence L Radics
- Institute of Pathology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | | | - Laszlo Szpisjak
- Department of Neurology, Albert Szent-Györgyi Medical School, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Adam Annus
- Department of Neurology, Albert Szent-Györgyi Medical School, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Denes Zadori
- Department of Neurology, Albert Szent-Györgyi Medical School, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Gabor G Kovacs
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Peter Klivenyi
- Department of Neurology, Albert Szent-Györgyi Medical School, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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5
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Muir RT, Ismail Z, Black SE, Smith EE. Comparative methods for quantifying plasma biomarkers in Alzheimer's disease: Implications for the next frontier in cerebral amyloid angiopathy diagnostics. Alzheimers Dement 2024; 20:1436-1458. [PMID: 37908054 PMCID: PMC10916950 DOI: 10.1002/alz.13510] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 11/02/2023]
Abstract
Plasma amyloid beta (Aβ) and tau are emerging as accessible biomarkers for Alzheimer's disease (AD). However, many assays exist with variable test performances, highlighting the need for a comparative assessment to identify the most valid assays for future use in AD and to apply to other settings in which the same biomarkers may be useful, namely, cerebral amyloid angiopathy (CAA). CAA is a progressive cerebrovascular disease characterized by deposition of Aβ40 and Aβ42 in cortical and leptomeningeal vessels. Novel immunotherapies for AD can induce amyloid-related imaging abnormalities resembling CAA-related inflammation. Few studies have evaluated plasma biomarkers in CAA. Identifying a CAA signature could facilitate diagnosis, prognosis, and a safer selection of patients with AD for emerging immunotherapies. This review evaluates studies that compare the diagnostic test performance of plasma biomarker techniques in AD and cerebrovascular and plasma biomarker profiles of CAA; it also discusses novel hypotheses and future avenues for plasma biomarker research in CAA.
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Affiliation(s)
- Ryan T. Muir
- Calgary Stroke ProgramDepartment of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahinoor Ismail
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of PsychiatryUniversity of CalgaryCalgaryAlbertaCanada
| | - Sandra E. Black
- Division of NeurologyDepartment of MedicineSunnybrook Health Sciences CentreTorontoOntarioCanada
- LC Campbell Cognitive Neurology Research UnitDr Sandra Black Centre for Brain Resilience and Recovery, and Hurvitz Brain Sciences ProgramSunnybrook Research InstituteUniversity of TorontoTorontoOntarioCanada
| | - Eric E. Smith
- Calgary Stroke ProgramDepartment of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
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Mkhitaryan EA, Fateeva VV, Kamchatnov PR. [Cerebral amyloid angiopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:85-90. [PMID: 38465814 DOI: 10.17116/jnevro202412402185] [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] [Indexed: 03/12/2024]
Abstract
Cerebral amyloid angiopathy (CAA) is a progressive disease characterized by the deposition of β-amyloid in the walls of blood vessels in the brain, which leads to their damage and disruption of normal blood flow. Morphologically, CAA is characterized by both isolated lesions (microhemorrhages with the appearance of cortical superficial siderosis, lacunar infarctions) and widespread changes (hyperintensity of the deep and periventricular white matter, expansion of the perivascular spaces) of cortical and subcortical localization. CAA is considered a major cause of cognitive impairment and intracerebral microbleeds, especially in patients with Alzheimer's disease. The review presents modern ideas about the etiology, pathogenesis, clinical manifestations of CAA, and also outlines the provisions of the Boston principles of CAA, revised in 2022. Understanding the features of pathogenetic methods of CAA is crucial for adjusting the accuracy of diagnosis and developing treatment methods to preserve and prolong cognitive health.
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Affiliation(s)
- E A Mkhitaryan
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - V V Fateeva
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - P R Kamchatnov
- Pirogov Russian National Research Medical University, Moscow, Russia
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Thal DR, Gawor K. Cerebral amyloid angiopathy: Neuropathological diagnosis, link to Alzheimer's disease and impact on clinics. Clin Neuropathol 2023; 42:176-189. [PMID: 37489069 DOI: 10.5414/np301564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 07/26/2023] Open
Abstract
Cerebral amyloid angiopathy (CAA) is the most frequent cause of lobar hemorrhages in the brains of elderly individuals. It is characterized by the deposition of amyloidogenic proteins in the vessel wall of leptomeningeal and/or intracerebral blood vessels. Different proteins can cause CAA. Most frequently, the amyloid β protein (Aβ) is found to be deposited in CAA and indicates a link to Alzheimer's disease, because Aβ is known to be deposited in amyloid plaques characteristic of Alzheimer's disease. Among other proteins that can also cause CAA, transthyretin (TTR) is the most important one because TTR amyloidosis can be successfully treated. Therefore, it is essential to diagnose TTR-related CAA even in biopsies taken in the context of cerebral hematoma evacuations if possible. The current "Boston criteria version 2.0" for the diagnosis of CAA highlight the importance of autopsy for the definite diagnosis of CAA and biopsies for the diagnosis of probable CAA. Here, we discuss the implications of Aβ-related and non-Aβ-related forms of CAA for their current diagnostic relevance also in the context of neurodegenerative diseases as well as the implications of the Boston criteria version 2.0 for neuropathological diagnosis.
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Miller ML, Griepp DW, Sun Y, Tamir S, Farber RS, Otten ML, Al‐Dalahmah O. A 53-year-old woman with a rapidly progressive, non-enhancing left frontotemporal lesion. Brain Pathol 2023; 33:e13125. [PMID: 36346825 PMCID: PMC10041067 DOI: 10.1111/bpa.13125] [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: 12/20/2021] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Fifty-three-year-old woman presented with chronic, episodic headache.
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Affiliation(s)
- Michael L. Miller
- Department of Pathology and Cell BiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Daniel W. Griepp
- Department of Pathology and Cell BiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of Medical EducationNew York Institute of TechnologyOld WestburyNew YorkUSA
- Present address:
Division of Neurosurgery, Ascension Providence HospitalCollege of Human Medicine, Michigan State UniversitySouthfieldMI48075USA
| | - Yu Sun
- Department of Pathology and Cell BiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Sean Tamir
- Department of RadiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | | | - Marc L. Otten
- Department of Neurological SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Osama Al‐Dalahmah
- Department of Pathology and Cell BiologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
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9
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Biessels GJ, Costa AS. Cerebral Amyloid Angiopathy-How to Translate Updated Diagnostic Criteria for This Multifaceted Disorder to Clinical Practice? JAMA Neurol 2023; 80:225-226. [PMID: 36689205 DOI: 10.1001/jamaneurol.2022.5060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This Viewpoint discusses recent efforts to update diagnostic criteria for cerebral amyloid angiopathy as well as questions and challenges in counseling patients about prognosis and deciding on optimal treatment.
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Affiliation(s)
- Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ana Sofia Costa
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Center Juelich and RWTH Aachen, Aachen, Germany
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Inoue Y, Nakajima M, Inatomi Y, Masuda T, Misumi Y, Nomura T, Uetani H, Hirai T, Ueda M. Reversible Periventricular Hyperintensity Lesions in Cerebral Amyloid Angiopathy: A Case Mimicking Cerebral Amyloid Angiopathy-related Inflammation. Intern Med 2022; 61:3581-3584. [PMID: 35569976 PMCID: PMC9790795 DOI: 10.2169/internalmedicine.8630-21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A 59-year-old man with progressive cognitive decline and mood disturbances was admitted to the hospital. Brain magnetic resonance imaging revealed marked white matter hyperintensity (WMH) and widespread lobar cerebral microbleeds. Because he had untreated hypertension, we started antihypertensive treatment and found a significantly improved cognitive function and WMH regression. We diagnosed him with cerebral amyloid angiopathy (CAA) based on the modified Boston Criteria with the rare apolipoprotein E (ApoE) ε2/ε4 genotype. The mechanism underlying reversible leukoencephalopathy in CAA may be related to the loss of autoregulation of brain circulation: cerebrovascular amyloid β deposits damaged the blood-brain barrier of the capillaries, which led to vasogenic edema induced by blood pressure surges.
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Affiliation(s)
- Yasuteru Inoue
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | | | - Teruaki Masuda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Yohei Misumi
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Toshiya Nomura
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Hiroyuki Uetani
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
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Bhattacharyya S, Gonzalez RG, Chwalisz BK, Champion SN. Case 22-2021: A 64-Year-Old Woman with Cognitive Impairment, Headache, and Memory Loss. N Engl J Med 2021; 385:358-368. [PMID: 34289280 DOI: 10.1056/nejmcpc2103460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Shamik Bhattacharyya
- From the Department of Neurology, Brigham and Women's Hospital (S.B.), the Departments of Radiology (R.G.G.), Neurology (B.K.C.), and Pathology (S.N.C.), Massachusetts General Hospital, and the Departments of Neurology (S.B., B.K.C.), Radiology (R.G.G.), and Pathology (S.N.C.), Harvard Medical School - all in Boston
| | - R Gilberto Gonzalez
- From the Department of Neurology, Brigham and Women's Hospital (S.B.), the Departments of Radiology (R.G.G.), Neurology (B.K.C.), and Pathology (S.N.C.), Massachusetts General Hospital, and the Departments of Neurology (S.B., B.K.C.), Radiology (R.G.G.), and Pathology (S.N.C.), Harvard Medical School - all in Boston
| | - Bart K Chwalisz
- From the Department of Neurology, Brigham and Women's Hospital (S.B.), the Departments of Radiology (R.G.G.), Neurology (B.K.C.), and Pathology (S.N.C.), Massachusetts General Hospital, and the Departments of Neurology (S.B., B.K.C.), Radiology (R.G.G.), and Pathology (S.N.C.), Harvard Medical School - all in Boston
| | - Samantha N Champion
- From the Department of Neurology, Brigham and Women's Hospital (S.B.), the Departments of Radiology (R.G.G.), Neurology (B.K.C.), and Pathology (S.N.C.), Massachusetts General Hospital, and the Departments of Neurology (S.B., B.K.C.), Radiology (R.G.G.), and Pathology (S.N.C.), Harvard Medical School - all in Boston
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12
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Palmieri I, Valente M, Farina LM, Gana S, Minafra B, Zangaglia R, Pansarasa O, Sproviero D, Costa A, Pacchetti C, Pichiecchio A, Gagliardi S, Cereda C. PSEN1 Compound Heterozygous Mutations Associated with Cerebral Amyloid Angiopathy and Cognitive Decline Phenotype. Int J Mol Sci 2021; 22:ijms22083870. [PMID: 33918046 PMCID: PMC8069161 DOI: 10.3390/ijms22083870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 01/22/2023] Open
Abstract
Cerebral amyloid angiopathy (CAA) is a cerebrovascular disorder caused by the deposition of amyloid beta-peptide (Aβ) aggregates. Aβ aggregates lead to vessel rupture and intracerebral hemorrhages, detected by magnetic resonance imaging (MRI). Presenile CAA is usually genetically determined by mutations in the amyloid precursor protein (APP) gene. However, mutations after codon 200 in the presenilin 1 (PSEN1) gene have been reported to facilitate CAA onset. Here, we analyzed the genetic bases in a patient of 55 years old affected by CAA and cognitive decline. DNA was isolated and genetic analysis was performed by Next-Generation Sequencing (NGS). RNA was extracted and retro-transcribed to perform segregation analysis by TOPO-TA cloning. WB analysis was carried out to check the impact of the mutations on protein. Two compound heterozygous mutations in PSEN1 exon 10, such as a novel stop-gain mutation (c.1070C > G) and a pathogenic splice variant (c.1129A > T), were found by NGS. Both mutations altered the presenilin 1 protein, truncating its C-terminal portion. This is the first case of CAA and cognitive decline caused by two compound mutations in PSEN1. With this report, we suggest extending the genetic analysis to PSEN1 when cerebral microbleeds are observed by MRI investigation in a patient affected by presenile cognitive decline.
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Affiliation(s)
- Ilaria Palmieri
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (I.P.); (O.P.); (D.S.); (C.C.)
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Marialuisa Valente
- Laboratory of Clinical Pathology Microbiology and Genetics, SS. Annunziata Hospital, 74100 Taranto, Italy;
| | - Lisa Maria Farina
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.M.F.); (A.P.)
| | - Simone Gana
- Medical Genetics Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Brigida Minafra
- Parkinson and Movement Disorders Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (B.M.); (R.Z.); (C.P.)
| | - Roberta Zangaglia
- Parkinson and Movement Disorders Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (B.M.); (R.Z.); (C.P.)
| | - Orietta Pansarasa
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (I.P.); (O.P.); (D.S.); (C.C.)
| | - Daisy Sproviero
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (I.P.); (O.P.); (D.S.); (C.C.)
| | - Alfredo Costa
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Claudio Pacchetti
- Parkinson and Movement Disorders Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (B.M.); (R.Z.); (C.P.)
| | - Anna Pichiecchio
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, 27100 Pavia, Italy; (L.M.F.); (A.P.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Stella Gagliardi
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (I.P.); (O.P.); (D.S.); (C.C.)
- Correspondence: ; Tel.: +39-038-238-0248
| | - Cristina Cereda
- Genomic and Post-Genomic Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (I.P.); (O.P.); (D.S.); (C.C.)
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13
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Inoue Y, Ando Y, Misumi Y, Ueda M. Current Management and Therapeutic Strategies for Cerebral Amyloid Angiopathy. Int J Mol Sci 2021; 22:ijms22083869. [PMID: 33918041 PMCID: PMC8068954 DOI: 10.3390/ijms22083869] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 12/18/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is characterized by accumulation of amyloid β (Aβ) in walls of leptomeningeal vessels and cortical capillaries in the brain. The loss of integrity of these vessels caused by cerebrovascular Aβ deposits results in fragile vessels and lobar intracerebral hemorrhages. CAA also manifests with progressive cognitive impairment or transient focal neurological symptoms. Although development of therapeutics for CAA is urgently needed, the pathogenesis of CAA remains to be fully elucidated. In this review, we summarize the epidemiology, pathology, clinical and radiological features, and perspectives for future research directions in CAA therapeutics. Recent advances in mass spectrometric methodology combined with vascular isolation techniques have aided understanding of the cerebrovascular proteome. In this paper, we describe several potential key CAA-associated molecules that have been identified by proteomic analyses (apolipoprotein E, clusterin, SRPX1 (sushi repeat-containing protein X-linked 1), TIMP3 (tissue inhibitor of metalloproteinases 3), and HTRA1 (HtrA serine peptidase 1)), and their pivotal roles in Aβ cytotoxicity, Aβ fibril formation, and vessel wall remodeling. Understanding the interactions between cerebrovascular Aβ deposits and molecules that accumulate with Aβ may lead to discovery of effective CAA therapeutics and to the identification of biomarkers for early diagnosis.
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Affiliation(s)
- Yasuteru Inoue
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; (Y.M.); (M.U.)
- Correspondence: ; Tel.: +81-96-373-5893; Fax: +81-96-373-5895
| | - Yukio Ando
- Department of Amyloidosis Research, Nagasaki International University, Sasebo 859-3298, Japan;
| | - Yohei Misumi
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; (Y.M.); (M.U.)
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan; (Y.M.); (M.U.)
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14
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Reimer JMB, Deodatus JA, Nguyen TKM, den Hertog MH. [Cerebral amyloid angiopathy: an easily missed diagnosis in patients with transient neurological deficits]. Ned Tijdschr Geneeskd 2021; 165:D5337. [PMID: 33651505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is a degenerative neurovascular disease in which the protein amyloid-beta accumulates in the vessel wall of cortical and leptomeningeal arteries. This may lead to acute lobar cerebral haemorrhage, which in case of CAA is fatal in 10-30% of cases. CAA may also present with transient focal neurological episodes (TFNE), the symptoms of which may mimic a transient ischaemic attack (TIA). Distinction between the two has important implications for therapy, as antithrombotics are relatively contra-indicated in CAA, but indicated after a TIA. We describe a patient with transient focal neurological deficits who was initially treated with antithrombotic therapy for a suspected TIA. Eventually, the diagnosis CAA was made and antithrombotic treatment was ceased. This case stresses the importance of considering the diagnosis CAA with TFNE in patients presenting with transient neurological deficits, in order to avoid an unnecessarily increased risk of symptomatic and possibly fatal cerebral haemorrhage.
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Affiliation(s)
- J M B Reimer
- Isala, afd. Neurologie, Zwolle
- Contact: J. M.B. Reimer
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15
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Jung YH, Lee H, Kim HJ, Na DL, Han HJ, Jang H, Seo SW. Prediction of amyloid β PET positivity using machine learning in patients with suspected cerebral amyloid angiopathy markers. Sci Rep 2020; 10:18806. [PMID: 33139780 PMCID: PMC7608617 DOI: 10.1038/s41598-020-75664-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/13/2020] [Indexed: 12/31/2022] Open
Abstract
Amyloid-β(Aβ) PET positivity in patients with suspected cerebral amyloid angiopathy (CAA) MRI markers is predictive of a worse cognitive trajectory, and it provides insights into the underlying vascular pathology (CAA vs. hypertensive angiopathy) to facilitate prognostic prediction and appropriate treatment decisions. In this study, we applied two interpretable machine learning algorithms, gradient boosting machine (GBM) and random forest (RF), to predict Aβ PET positivity in patients with CAA MRI markers. In the GBM algorithm, the number of lobar cerebral microbleeds (CMBs), deep CMBs, lacunes, CMBs in dentate nuclei, and age were ranked as the most influential to predict Aβ positivity. In the RF algorithm, the absence of diabetes was additionally chosen. Cut-off values of the above variables predictive of Aβ positivity were as follows: (1) the number of lobar CMBs > 16.4(GBM)/14.3(RF), (2) no deep CMBs(GBM/RF), (3) the number of lacunes > 7.4(GBM/RF), (4) age > 74.3(GBM)/64(RF), (5) no CMBs in dentate nucleus(GBM/RF). The classification performances based on the area under the receiver operating characteristic curve were 0.83 in GBM and 0.80 in RF. Our study demonstrates the utility of interpretable machine learning in the clinical setting by quantifying the relative importance and cutoff values of predictive variables for Aβ positivity in patients with suspected CAA markers.
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Affiliation(s)
- Young Hee Jung
- Department of Neurology, College of Medicine, Myoungji Hospital, Hanyang University, Goyang, Republic of Korea
- Department of Neurology, Sungkyunkwan University of School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyejoo Lee
- Department of Neurology, Sungkyunkwan University of School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Sungkyunkwan University of School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Duk L Na
- Department of Neurology, Sungkyunkwan University of School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyun Jeong Han
- Department of Neurology, College of Medicine, Myoungji Hospital, Hanyang University, Goyang, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Sungkyunkwan University of School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.
- Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Sang Won Seo
- Department of Neurology, Sungkyunkwan University of School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.
- Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea.
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16
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Abstract
Primary angiitis of the central nervous system (CNS) is an inflammatory vasculopathy affecting the brain and spinal cord. It is a difficult diagnosis to make because of its insidious nonspecific course and its multiple mimics. This review identifies and discusses some noninfectious mimickers of primary CNS angiitis, including: reversible cerebral vasoconstriction syndrome, Sneddon's Syndrome, amyloid-beta-related angiopathy, Susac Syndrome, and neurosarcoidosis. Each condition will be reviewed in terms of epidemiology, pathology, clinical presentation, diagnostic approach, and treatment. Distinguishing these mimics from the primary angiitis of the CNS is important for proper treatment and prognosis.
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Affiliation(s)
| | - Ann Jones
- 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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17
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Ter Telgte A, Scherlek AA, Reijmer YD, van der Kouwe AJ, van Harten T, Duering M, Bacskai BJ, de Leeuw FE, Frosch MP, Greenberg SM, van Veluw SJ. Histopathology of diffusion-weighted imaging-positive lesions in cerebral amyloid angiopathy. Acta Neuropathol 2020; 139:799-812. [PMID: 32108259 DOI: 10.1007/s00401-020-02140-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/25/2020] [Accepted: 02/21/2020] [Indexed: 11/24/2022]
Abstract
Small subclinical hyperintense lesions are frequently encountered on brain diffusion-weighted imaging (DWI) scans of patients with cerebral amyloid angiopathy (CAA). Interpretation of these DWI+ lesions, however, has been limited by absence of histopathological examination. We aimed to determine whether DWI+ lesions represent acute microinfarcts on histopathology in brains with advanced CAA, using a combined in vivo MRI-ex vivo MRI-histopathology approach. We first investigated the histopathology of a punctate cortical DWI+ lesion observed on clinical in vivo MRI 7 days prior to death in a CAA case. Subsequently, we assessed the use of ex vivo DWI to identify similar punctate cortical lesions post-mortem. Intact formalin-fixed hemispheres of 12 consecutive cases with CAA and three non-CAA controls were subjected to high-resolution 3 T ex vivo DWI and T2 imaging. Small cortical lesions were classified as either DWI+/T2+ or DWI-/T2+. A representative subset of lesions from three CAA cases was selected for detailed histopathological examination. The DWI+ lesion observed on in vivo MRI could be matched to an area with evidence of recent ischemia on histopathology. Ex vivo MRI of the intact hemispheres revealed a total of 130 DWI+/T2+ lesions in 10/12 CAA cases, but none in controls (p = 0.022). DWI+/T2+ lesions examined histopathologically proved to be acute microinfarcts (classification accuracy 100%), characterized by presence of eosinophilic neurons on hematoxylin and eosin and absence of reactive astrocytes on glial fibrillary acidic protein-stained sections. In conclusion, we suggest that small DWI+ lesions in CAA represent acute microinfarcts. Furthermore, our findings support the use of ex vivo DWI as a method to detect acute microinfarcts post-mortem, which may benefit future histopathological investigations on the etiology of microinfarcts.
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Affiliation(s)
- Annemieke Ter Telgte
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ashley A Scherlek
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
| | - Yael D Reijmer
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andre J van der Kouwe
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Thijs van Harten
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco Duering
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Stroke and Dementia Research (ISD), University Hospital LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Brian J Bacskai
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthew P Frosch
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Susanne J van Veluw
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA.
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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18
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Affiliation(s)
- M. Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Louise D. McCullough
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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19
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Weldon Furr J, Morales-Scheihing D, Manwani B, Lee J, McCullough LD. Cerebral Amyloid Angiopathy, Alzheimer's Disease and MicroRNA: miRNA as Diagnostic Biomarkers and Potential Therapeutic Targets. Neuromolecular Med 2019; 21:369-390. [PMID: 31586276 DOI: 10.1007/s12017-019-08568-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/04/2019] [Indexed: 12/14/2022]
Abstract
The protein molecules must fold into unique conformations to acquire functional activity. Misfolding, aggregation, and deposition of proteins in diverse organs, the so-called "protein misfolding disorders (PMDs)", represent the conformational diseases with highly ordered assemblies, including oligomers and fibrils that are linked to neurodegeneration in brain illnesses such as cerebral amyloid angiopathy (CAA) and Alzheimer's disease (AD). Recent studies have revealed several aspects of brain pathology in CAA and AD, but both the classification and underlying mechanisms need to be further refined. MicroRNAs (miRNAs) are critical regulators of gene expression at the post-transcriptional level. Increasing evidence with the advent of RNA sequencing technology suggests possible links between miRNAs and these neurodegenerative disorders. To provide insights on the small RNA-mediated regulatory circuitry and the translational significance of miRNAs in PMDs, this review will discuss the characteristics and mechanisms of the diseases and summarize circulating or tissue-resident miRNAs associated with AD and CAA.
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Affiliation(s)
- J Weldon Furr
- BRAINS Research Laboratory, University of Texas McGovern Medical School, Houston, TX, 77030, USA
| | - Diego Morales-Scheihing
- BRAINS Research Laboratory, University of Texas McGovern Medical School, Houston, TX, 77030, USA
| | - Bharti Manwani
- BRAINS Research Laboratory, University of Texas McGovern Medical School, Houston, TX, 77030, USA
| | - Juneyoung Lee
- BRAINS Research Laboratory, University of Texas McGovern Medical School, Houston, TX, 77030, USA
| | - Louise D McCullough
- BRAINS Research Laboratory, University of Texas McGovern Medical School, Houston, TX, 77030, USA.
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20
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Carmona-Iragui M, Videla L, Lleó A, Fortea J. Down syndrome, Alzheimer disease, and cerebral amyloid angiopathy: The complex triangle of brain amyloidosis. Dev Neurobiol 2019; 79:716-737. [PMID: 31278851 DOI: 10.1002/dneu.22709] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/04/2019] [Accepted: 07/02/2019] [Indexed: 11/07/2022]
Abstract
Down syndrome (DS) is the main genetic cause of intellectual disability worldwide. The overexpression of the Amyloid Precursor Protein, present in chromosome 21, leads to β-amyloid deposition that results in Alzheimer disease (AD) and, in most cases, also to cerebral amyloid angiopathy (CAA) neuropathology. People with DS invariably develop the neuropathological hallmarks of AD at the age of 40, and they are at an ultra high risk for suffering AD-related cognitive impairment thereafter. In the general population, cerebrovascular disease is a significant contributor to AD-related cognitive impairment, while in DS remains understudied. This review describes the current knowledge on cerebrovascular disease in DS and reviews the potential biomarkers that could be useful in the future studies, focusing on CAA. We also discuss available evidence on sporadic AD or other genetically determined forms of AD. We highlight the urgent need of large biomarker-characterized cohorts, including neuropathological correlations, to study the exact contribution of CAA and related vascular factors that play a role in cognition and occur with aging, their characterization and interrelationships. DS represents a unique context in which to perform these studies as this population is relatively protected from some conventional vascular risk factors and they develop significant CAA, DS represents a particular atheroma-free model to study AD-related vascular pathologies. Only deepening on these underlying mechanisms, new preventive and therapeutic strategies could be designed to improve the quality of life of this population and their caregivers and lead to new avenues of treatment also in the general AD population.
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Affiliation(s)
- María Carmona-Iragui
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Laura Videla
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau- Biomedical Research Institute Sant Pau- Universitat Autònoma de Barcelona, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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21
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Morinaga Y, Nii K, Sakamoto K, Inoue R, Mitsutake T, Hanada H. [A Case of Cerebral Amyloid Angiopathy-related Subarachnoid Hemorrhage with Parkinson Disease Dementia]. No Shinkei Geka 2019; 47:883-892. [PMID: 31477632 DOI: 10.11477/mf.1436204040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report a case of cerebral amyloid angiopathy(CAA)-related subarachnoid hemorrhage(SAH)with Parkinson's disease dementia(PDD), along with a literature review. CASE: A 67-year-old woman with a history of Parkinson's disease was diagnosed with SAH(World Federation of Neurosurgical Societies grade I). The plain head CT performed on admission, revealed an atypical hematoma distribution. Blood sampling, MRI and cerebral angiography revealed no vascular abnormalities, meningitis, encephalitis, or primary angiitis of the central nervous system. MRI performed on the third day after admission confirmed the presence of bilateral cortical or subcortical hemorrhage in the parietal lobe, with amyloid-related imaging abnormalities. A preliminary diagnosis of CAA was made, based on the Boston criteria. She was also diagnosed with PDD, based on the cognitive decline during hospitalization. CONCLUSION: Stroke related with CAA, as seen in SAH, may contribute to cognitive decline and the progression of lesions in PDD.
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Affiliation(s)
- Yusuke Morinaga
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
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22
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Eliahou R, Auriel E, Gomori M, Sosna J, Honig A. [SPONTANEOUS PARENCHYMAL INTRACRANIAL HEMORRHAGE - A DIAGNOSTIC CHALLENGE]. Harefuah 2018; 157:158-161. [PMID: 29582945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Non-traumatic intracranial hemorrhage (ICH) is a devastating event associated with a high rate of morbidity and mortality. Patient age, hemorrhage location, number of foci, and underlying diseases are important clues to the etiology. Non-contrast head CT, given its availability and high sensitivity in detecting blood products, is frequently the first tool to readily detect ICH; however, different types of hemorrhages may share a common appearance on CT and the optimal therapeutic approach varies depending on etiology. An additional diagnostic work-up is frequently indicated to make the final diagnosis and to assist in urgent patient management. CT- and MR angiography, and digital angiography can diagnose vascular anomalies, CT venography can reveal cerebral vein thrombosis, diffusion-weighted MRI (DWI) may show hemorrhagic transformation of an infarct, and susceptibility-weighted MRI (SWI) may detect hypertensive and amyloid angiopathy-related microbleeds. MR also has a major role in revealing underlying etiologies such as cavernoma, primary brain tumor or metastases. These imaging tools assist in determining the cause of ICH, and also in assessing the risk of deterioration. Prognostic factors such as size, location, mass effect, and detection of the "spot sign" all play an important role in foreseeing possible deterioration, thus allowing prompt intervention. This study will present cases of intraparenchymal hemorrhage from different etiologies in patients who presented to the Hadassah-Hebrew University Medical Center, with the goal of illustrating the role of imaging in patient management and decision-making.
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Affiliation(s)
- Ruth Eliahou
- Department of Radiology, Hadassah Medical Center, Jerusalem Israel
| | - Eitan Auriel
- Department of Neurology, Tel Aviv Medical Center, Israel
| | - Moshe Gomori
- Department of Radiology, Hadassah Medical Center, Jerusalem Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Jerusalem Israel
| | - Asaf Honig
- Department of Neurology, Hadassah Medical Center, Jerusalem Israel
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Rodrigues MA, Samarasekera N, Lerpiniere C, Humphreys C, McCarron MO, White PM, Nicoll JAR, Sudlow CLM, Cordonnier C, Wardlaw JM, Smith C, Al-Shahi Salman R. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurol 2018; 17:232-240. [PMID: 29331631 PMCID: PMC5818029 DOI: 10.1016/s1474-4422(18)30006-1] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Identification of lobar spontaneous intracerebral haemorrhage associated with cerebral amyloid angiopathy (CAA) is important because it is associated with a higher risk of recurrent intracerebral haemorrhage than arteriolosclerosis-associated intracerebral haemorrhage. We aimed to develop a prediction model for the identification of CAA-associated lobar intracerebral haemorrhage using CT features and genotype. METHODS We identified adults with first-ever intracerebral haemorrhage diagnosed by CT, who died and underwent research autopsy as part of the Lothian IntraCerebral Haemorrhage, Pathology, Imaging and Neurological Outcome (LINCHPIN) study, a prospective, population-based, inception cohort. We determined APOE genotype and radiologists rated CT imaging appearances. Radiologists were not aware of clinical, genetic, and histopathological features. A neuropathologist rated brain tissue for small vessel diseases, including CAA, and was masked to clinical, radiographic, and genetic features. We used CT and APOE genotype data in a logistic regression model, which we internally validated using bootstrapping, to predict the risk of CAA-associated lobar intracerebral haemorrhage, derive diagnostic criteria, and estimate diagnostic accuracy. FINDINGS Among 110 adults (median age 83 years [IQR 76-87], 49 [45%] men) included in the LINCHPIN study between June 1, 2010 and Feb 10, 2016, intracerebral haemorrhage was lobar in 62 (56%) participants, deep in 41 (37%), and infratentorial in seven (6%). Of the 62 participants with lobar intracerebral haemorrhage, 36 (58%) were associated with moderate or severe CAA compared with 26 (42%) that were associated with absent or mild CAA, and were independently associated with subarachnoid haemorrhage (32 [89%] of 36 vs 11 [42%] of 26; p=0·014), intracerebral haemorrhage with finger-like projections (14 [39%] of 36 vs 0; p=0·043), and APOE ɛ4 possession (18 [50%] of 36 vs 2 [8%] of 26; p=0·0020). A prediction model for CAA-associated lobar intracerebral haemorrhage using these three variables had excellent discrimination (c statistic 0·92, 95% CI 0·86-0·98), confirmed by internal validation. For the rule-out criteria, neither subarachnoid haemorrhage nor APOE ɛ4 possession had 100% sensitivity (95% CI 88-100). For the rule-in criteria, subarachnoid haemorrhage and either APOE ɛ4 possession or finger-like projections had 96% specificity (95% CI 78-100). INTERPRETATION The CT and APOE genotype prediction model for CAA-associated lobar intracerebral haemorrhage shows excellent discrimination in this cohort, but requires external validation. The Edinburgh rule-in and rule-out diagnostic criteria might inform prognostic and therapeutic decisions that depend on identification of CAA-associated lobar intracerebral haemorrhage. FUNDING UK Medical Research Council, The Stroke Association, and The Wellcome Trust.
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Affiliation(s)
- Mark A Rodrigues
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | | | - Catherine Humphreys
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Mark O McCarron
- Department of Neurology, Altnagelvin Hospital, Londonderry, UK
| | - Philip M White
- Institute of Neuroscience and Institute for Ageing, Newcastle University, Newcastle-upon-Tyne, UK; Newcastle upon Tyne Hospitals National Health Services Foundation Trust, Newcastle-upon-Tyne, UK
| | - James A R Nicoll
- Clinical Neurosciences, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Cathie L M Sudlow
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Charlotte Cordonnier
- Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at The University of Edinburgh, The University of Edinburgh, Edinburgh, UK; Row Fogo Centre for Research into Ageing and the Brain, The University of Edinburgh, Edinburgh, UK
| | - Colin Smith
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Greenberg SM, Charidimou A. Diagnosis of Cerebral Amyloid Angiopathy: Evolution of the Boston Criteria. Stroke 2018; 49:491-497. [PMID: 29335334 PMCID: PMC5892842 DOI: 10.1161/strokeaha.117.016990] [Citation(s) in RCA: 263] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Steven M Greenberg
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Boston.
| | - Andreas Charidimou
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Boston
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Samarasekera N, Rodrigues MA, Toh PS, Salman RAS. Imaging features of intracerebral hemorrhage with cerebral amyloid angiopathy: Systematic review and meta-analysis. PLoS One 2017; 12:e0180923. [PMID: 28700676 PMCID: PMC5507310 DOI: 10.1371/journal.pone.0180923] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/23/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We sought to summarize Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) features of intracerebral hemorrhage (ICH) associated with cerebral amyloid angiopathy (CAA) in published observational radio-pathological studies. METHODS In November 2016, two authors searched OVID Medline (1946-), Embase (1974-) and relevant bibliographies for studies of imaging features of lobar or cerebellar ICH with pathologically proven CAA ("CAA-associated ICH"). Two authors assessed studies' diagnostic test accuracy methodology and independently extracted data. RESULTS We identified 22 studies (21 cases series and one cross-sectional study with controls) of CT features in 297 adults, two cross-sectional studies of MRI features in 81 adults and one study which reported both CT and MRI features in 22 adults. Methods of CAA assessment varied, and rating of imaging features was not masked to pathology. The most frequently reported CT features of CAA-associated ICH in 21 case series were: subarachnoid extension (pooled proportion 82%, 95% CI 69-93%, I2 = 51%, 12 studies) and an irregular ICH border (64%, 95% CI 32-91%, I2 = 85%, five studies). CAA-associated ICH was more likely to be multiple on CT than non-CAA ICH in one cross-sectional study (CAA-associated ICH 7/41 vs. non-CAA ICH 0/42; χ2 = 7.8, p = 0.005). Superficial siderosis on MRI was present in 52% of CAA-associated ICH (95% CI 39-65%, I2 = 35%, 3 studies). CONCLUSIONS Subarachnoid extension and an irregular ICH border are common imaging features of CAA-associated ICH, but methodologically rigorous diagnostic test accuracy studies are required to determine the sensitivity and specificity of these features.
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Affiliation(s)
- Neshika Samarasekera
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Pheng Shiew Toh
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Abstract
Zusammenfassung. Zerebrale Mikroangiopathien umfassen eine Gruppe neuropathologischer Prozesse, die die kleinen Perforationsarterien, Arteriolen und Kapillaren beeinflussen. Neuroimaging-Merkmale der Einengung der kleinen Koronararterienäste (Small Vessel Disease) sind ischämische und hämorrhagische Marker: jüngster kleiner subkortikaler Infarkt, Lakune vermuteten vaskulären Ursprungs, Hyperintensität der weissen Masse, perivaskuläre Räume, zerebrale Mikroblutungen, Hirnatrophie, kortikale oberflächliche Siderose und akute subarachnoidale Blutungen. Diese Läsionen gelten als der Hauptrisikofaktor der vaskulären kognitiven Störungen. Die zerebrale Mikroangiopathie wird typischerweise in zwei Hauptformen kategorisiert: die nicht-amyloide Angiopathie, die auch als «hypertensive Arteriopathie» bezeichnet wird, die oft mit fortgeschrittenem Alter und vaskulären Risikofaktoren und der zerebralen Amyloidangiopathie zusammenhängt. Die zerebrale Amyloidangiopathie ist klinisch charakterisiert durch kognitive Beeinträchtigungen, intrazerebrale Blutungen und durch transiente Episoden fokal-neurologischer Defizite aufgrund von Subarachnoidalblutungen.
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Affiliation(s)
- Agnès Jacquin-Piques
- 1 Centre Mémoire, Ressources et Recherche - Département de Neurologie, Centre Hospitalier Universitaire Dijon - Bourgogne, Dijon, France
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Bulwa ZB, Ward GC, Kramer ON, Rao B, Wichter M. Rapidly Sequential and Fatal Hemorrhaging in a Case of Cerebral Amyloid Angiopathy. Am J Case Rep 2016; 17:860-863. [PMID: 27853131 PMCID: PMC5115614 DOI: 10.12659/ajcr.900498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 08/24/2016] [Indexed: 12/04/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is an increasingly recognized cause of lobar intracerebral hemorrhage (ICH) and cognitive impairment in the aging population. Magnetic resonance imaging (MRI) of cerebral microbleeds is the most reliable option for clinical diagnosis of suspected CAA. The pathophysiology of microbleeds and ICH in CAA is not well understood, but it is thought to be the result of vessel weakening and rupture secondary to amyloid deposition. Little evidence has been established pertaining to the time course of recurrent CAA-related microbleeds or larger hemorrhages. Although several risk factors have been associated with an increased risk of ICH in CAA, there are no current treatment guidelines for recurrent hemorrhaging in CAA. CASE REPORT We present a rare case of rapidly sequential and fatal lobar hemorrhaging in the setting of suspected CAA, diagnosed by numerous microbleeds on MRI, compounded by the use of subcutaneous heparin in a 63-year-old female patient. CONCLUSIONS This case broadens our understanding of a rarely identified progression of CAA and illustrates the need for further investigation of the use of subcutaneous heparin in the setting of probable CAA.
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Affiliation(s)
- Zachary B. Bulwa
- Department of Internal Medicine, University of Chicago – NorthShore University Health System, Evanston, IL, U.S.A
| | - G. Carter Ward
- Department of Family Medicine, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - Owen N. Kramer
- Department of Neurology, University of Illinois at Chicago, Chicago, IL, U.S.A
| | - Birju Rao
- Department of Neurology, University of Illinois at Chicago, Chicago, IL, U.S.A
| | - Melvin Wichter
- Department of Neurology, Advocate Christ Medical Center, Oak Lawn, IL, U.S.A
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Kovacs GG, Lutz MI, Ricken G, Ströbel T, Höftberger R, Preusser M, Regelsberger G, Hönigschnabl S, Reiner A, Fischer P, Budka H, Hainfellner JA. Dura mater is a potential source of Aβ seeds. Acta Neuropathol 2016; 131:911-23. [PMID: 27016065 PMCID: PMC4865536 DOI: 10.1007/s00401-016-1565-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 12/14/2022]
Abstract
Deposition of amyloid-β (Aβ) in the brain parenchyma and vessels is one of the hallmarks of Alzheimer disease (AD). Recent observations of Aβ deposition in iatrogenic Creutzfeldt-Jakob disease (iCJD) after dural grafting or treatment with pituitary extracts raised concerns whether Aβ is capable of transmitting disease as seen in prion diseases by the disease-associated prion protein. To address this issue, we re-sampled and re-evaluated archival material, including the grafted dura mater of two cases with iCJD (28 and 33-years-old) without mutations in the AβPP, PSEN1 and PSEN2 genes, and carrying ε3/ε3 alleles of the APOE gene. In addition, we evaluated 84 dura mater samples obtained at autopsy (mean age 84.9 ± 0.3) in the community-based VITA study for the presence of Aβ deposition. We show that the dura mater may harbor Aβ deposits (13 %) in the form of cerebral amyloid angiopathy or amorphous aggregates. In both iCJD cases, the grafted dura mater had accumulated Aβ. The morphology and distribution pattern of cerebral Aβ deposition together with the lack of tau pathology distinguishes the Aβ proteinopathy in iCJD from AD, from that seen in young individuals without cognitive decline carrying one or two APOE4 alleles, and from that related to traumatic brain injury. Our novel findings of Aβ deposits in the dura mater, including the grafted dura, and the distinct cerebral Aβ distribution in iCJD support the seeding properties of Aβ. However, in contrast to prion diseases, our study suggests that such Aβ seeding is unable to reproduce the full clinicopathological phenotype of AD.
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Affiliation(s)
- Gabor G Kovacs
- Institute of Neurology, Medical University Vienna, AKH 4J, Währinger Gürtel 18-20, 1097, Vienna, Austria.
| | - Mirjam I Lutz
- Institute of Neurology, Medical University Vienna, AKH 4J, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Gerda Ricken
- Institute of Neurology, Medical University Vienna, AKH 4J, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Thomas Ströbel
- Institute of Neurology, Medical University Vienna, AKH 4J, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Romana Höftberger
- Institute of Neurology, Medical University Vienna, AKH 4J, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I and Comprehensive Cancer Center CNS Unit, Medical University Vienna, Vienna, Austria
| | - Günther Regelsberger
- Institute of Neurology, Medical University Vienna, AKH 4J, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | | | - Angelika Reiner
- Institute of Pathology, Danube Hospital Vienna, Vienna, Austria
| | - Peter Fischer
- Psychiatric Department, Medical Research Society Vienna, D.C., Danube Hospital, Vienna, Austria
| | - Herbert Budka
- Institute of Neurology, Medical University Vienna, AKH 4J, Währinger Gürtel 18-20, 1097, Vienna, Austria
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Johannes A Hainfellner
- Institute of Neurology, Medical University Vienna, AKH 4J, Währinger Gürtel 18-20, 1097, Vienna, Austria
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Abstract
Vigorous investigations for cerebral microbleeds (CMBs) have been made since the late 1990s. CMBs on paramagnetic-sensitive magnetic resonance sequences correspond pathologically to clusters of hemosiderin-laden macrophages and have emerged as an important new imaging marker of cerebral small vessel disease, including intracerebral hemorrhage (ICH). The prevalence of CMBs varies according to the specific disease settings (stroke subtypes and dementing disorders) and is highest (60%) in ICH patients. The associations of CMBs with aging, hypertension and apolipoprotein E genotype are consistent with the two major underlying pathogeneses of CMBs: hypertensive arteriopathy and cerebral amyloid angiopathy (CAA). The distributional patterns of CMBs might help us to understand the predominant small vessel disease pathogenesis in the brain; the strictly lobar type of CMBs often reflects the presence of advanced CAA, while the other types of CMBs, such as 'deep or infratentorial CMBs', including the mixed type, are strongly associated with hypertension. CMBs might be associated with cognitive function (especially executive function), gait performance, and cerebrovascular events (spontaneous, antithrombotic drug-related or post-thrombolysis ICH). In the field of CAA, an understanding of CAA-related CMBs might help to guide decision making with regard to new therapeutic approaches, including the use of monoclonal antibodies against vascular amyloid. These concepts of CMBs might allow us to advance research on ICH as well as for dementia.
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Affiliation(s)
- Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
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30
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Abstract
Spontaneous intracerebral haemorrhage (ICH) accounts for approximately 15% of all strokes and is a leading cause of disability, with a one-month mortality rate of 40%. Whereas factors predicting short-term mortality are well known, data regarding long-term outcome are scarce and imprecise. The two main underlying vasculopathies responsible for ICH, i.e. deep perforating vasculopathy and cerebral amyloid angiopathy, might have an impact on the overall prognosis of ICH survivors. ICH survivors are at high risk of epileptic seizures, depression and cognitive impairment, which may influence their functional outcome. Lobar location of an ICH, frequently due to cerebral amyloid angiopathy, partly determines the long-term risk of recurrent haemorrhage. Because of common vascular risk factors, patients with ICH are also at considerable risk of serious ischaemic events. Risks of future ischaemic events may be as high as that of recurrent ICH, raising the relevance of antithrombotic treatment in ICH survivors. Future studies of long-term follow-up after ICH are needed to determine predictors of outcome, including biomarkers of the underlying vasculopathies, to tailor preventive strategies to survivors.
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Patricio CM, Gabriela C, Julieta RM, Marcos FS, Federico N, Griselda R, Claudio W, Santiago P, Leonardo T, Jorge C, Alejandra A, Janus K, Salvador G, Ramon L, Gustavo S, Silvia V, Ricardo A. Concordance between 11C-PIB-PET and clinical diagnosis in a memory clinic. Am J Alzheimers Dis Other Demen 2015; 30:599-606. [PMID: 25817631 PMCID: PMC10852556 DOI: 10.1177/1533317515576387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Today, ligands that bind to fibrillar β-amyloid are detectable by Positron Emission Tomography (PET) allowing for in vivo visualization for Abeta burden. However, amyloid plaques detection per se does not establish Alzheimer's Disease diagnosis. In this sense, the utility of amyloid imaging to improve clinical diagnosis was settled only for specific clinical scenarios and few studies have assessed amyloid molecular neuroimaging in a broader clinical setting. The aim of this study is to determine the frequency of PiB amyloid findings in different diagnostic syndromes grouped into high and low probability pre- test categories, taking into account pre-test clinical assumption of the presence of AD related pathology. METHODS 144 patients were assigned into categories of high or low pretest probability according to clinical suspicion of AD pathology. The high probability group included: amnestic Mild Cognitive Impairment (MCI), amnestic and other domains MCI, Dementia of Alzheimer's Type (DAT), Posterior Cortical Atrophy (PCA), logopenic Primary Progressive Aphasia (PPA), Cerebral Amyloid Angiopathy and mixed dementia. The low assumption group included: normal controls, non-amnestic MCI, non-logopenic PPA and Frontotemporal Dementia (FTD). RESULTS Only normal controls and DAT patients (typical and atypical presentation) were the most consistent across clinical and molecular diagnostics. MCI, non-logopenic PPA and FTD were the syndromic diagnoses that most discrepancies were found. DISCUSSION This study demonstrates that detecting in vivo amyloid plaques by molecular imaging is considerably frequent in most of the dementia syndromes and shows that there are frequent discordance between molecular diagnosis and clinical assumption.
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Affiliation(s)
- Chrem Mendez Patricio
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Cohen Gabriela
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Russo Maria Julieta
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Fernandez Suarez Marcos
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Nahas Federico
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Russo Griselda
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Wierszylo Claudio
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Paz Santiago
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Tabaschi Leonardo
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Campos Jorge
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Amengual Alejandra
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Kremer Janus
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Guinjoan Salvador
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Leiguarda Ramon
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Sevlever Gustavo
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Vázquez Silvia
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
| | - Allegri Ricardo
- Ageing and Memory Center, Instituto de Investigaciones Neurologicas "Raúl Carrea" (FLENI), Buenos Aires, Argentina
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Cagle K, Berg A, Freeman J. Cerebral Amyloid Angiopathy with Angiitis: Emerging Options for Treatment. S D Med 2015; 68:293-296. [PMID: 26267928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Two cases of cerebral amyloid angiopathy with features of angiitis are reported. The role of immunosuppressive therapy is reviewed.
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33
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Affiliation(s)
- N Esfahani-Bayerl
- Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland,
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Calvo M, de Miguel C, Pinel A, Ortega JM, Aladro Y. [Diffuse superficial siderosis of the central nervous system: four case reports and review of the literature]. Rev Neurol 2014; 59:354-358. [PMID: 25297478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Diffuse superficial siderosis of the central nervous system (CNS) is a rare condition due to hemosiderin deposits in the subpial layers of the brain and spinal cord. The source of chronic or recurrent bleeding into the subarachnoid space is detected in only 50 % of cases. The most characteristic symptoms are cerebellar ataxia and sensorineural hearing impairment. T2-weighted gradient echo magnetic resonance imaging constitutes the diagnostic method of choice. CASE REPORTS We report four patients of diffuse superficial siderosis of the CNS associated to cerebral amyloid angiopathy, oral anticoagulation, schwannoma VIII, and without known source of bleeding in one case. Two patients developed cerebellar ataxia, three of them present transient focal neurological episodes, one dementia and, the last one, the diffuse superficial siderosis of the CNS is a radiological finding. No clinical progression was observed during follow-up (2-11 years) in three of them. The patient with cerebral amyloid angiopathy progresses to dementia. CONCLUSIONS Transient focal neurological episodes were the most common symptom in our cases of diffuse superficial siderosis of the CNS. The natural history of this condition is not very known and may be regarded as a radiological finding.
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Affiliation(s)
- Marta Calvo
- Hospital Universitario de Getafe, 28905 Getafe, Espana
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35
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Abstract
Cerebral amyloid angiopathy is a commonly occurring condition that is not familiar to most clinicians. A common presenting feature may be transient focal neurological symptoms leading to the potential for clinical misdiagnosis as transient ischaemic attack. This may result in the inappropriate use of anti-platelets and anticoagulants or radiological misdiagnosis. It is also being increasingly recognised as an important cause of spontaneous intracerebral haemorrhage and cognitive impairment in the elderly. Cerebral amyloid angiopathy can be diagnosed based on clinical and radiological findings, but clinicians need a high index of suspicion to ensure appropriate investigations are requested. In this article we aim to cover the pathophysiology, clinical findings, radiological appearances and approach to management of cerebral amyloid angiopathy.
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Nakazato Y. [Pathology of cerebral amyloid angiopathy: a review]. No Shinkei Geka 2014; 42:299-310. [PMID: 24698891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Lee MJ, Seo SW, Na DL, Kim C, Park JH, Kim GH, Kim CH, Noh Y, Cho H, Kim HJ, Yoon CW, Ye BS, Chin J, Jeon S, Lee JM, Choe YS, Lee KH, Kim JS, Kim ST, Lee JH, Ewers M, Werring DJ, Weiner MW. Synergistic effects of ischemia and β-amyloid burden on cognitive decline in patients with subcortical vascular mild cognitive impairment. JAMA Psychiatry 2014; 71:412-22. [PMID: 24554306 PMCID: PMC5849078 DOI: 10.1001/jamapsychiatry.2013.4506] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cerebrovascular disease (CVD) and Alzheimer disease are significant causes of cognitive impairment in the elderly. However, few studies have evaluated the relationship between CVD and β-amyloid burden in living humans or their synergistic effects on cognition. Thus, there is a need for better understanding of mild cognitive impairment (MCI) before clinical deterioration begins. OBJECTIVE To determine the synergistic effects of β-amyloid burden and CVD on cognition in patients with subcortical vascular MCI (svMCI). DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study was conducted using a hospital-based sample at a tertiary referral center. We prospectively recruited 95 patients with svMCI; 67 of these individuals participated in the study. Forty-five patients with amnestic MCI (aMCI) were group matched with those with svMCI by the Clinical Dementia Rating Scale Sum of Boxes. MAIN OUTCOMES AND MEASURES We measured β-amyloid burden using positron emission tomography with carbon 11-labeled Pittsburgh Compound B (PiB). Cerebrovascular disease was quantified as white matter hyperintensity volume detected by magnetic resonance imaging fluid-attenuated inversion recovery. Detailed neuropsychological tests were performed to determine the level of patients' cognitive impairment. RESULTS On evaluation, 22 of the svMCI group (33%) and 28 of the aMCI group (62%) were found to be PiB positive. The mean PiB retention ratio was lower in patients with svMCI than in those with aMCI. In svMCI, the PiB retention ratio was associated with cognitive impairments in multiple domains, including language, visuospatial, memory, and frontal executive functions, but was associated only with memory dysfunction in aMCI. A significant interaction between PiB retention ratio and white matter hyperintensity volume was found to affect visuospatial function in patients with svMCI. CONCLUSIONS AND RELEVANCE Most patients with svMCI do not exhibit substantial amyloid burden, and CVD does not increase β-amyloid burden as measured by amyloid imaging. However, in patients with svMCI, amyloid burden and white matter hyperintensity act synergistically to impair visuospatial function. Therefore, our findings highlight the need for accurate biomarkers, including neuroimaging tools, for early diagnosis and the need to relate these biomarkers to cognitive measurements for effective use in the clinical setting.
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Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyun Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Geon Ha Kim
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chi Hun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Noh
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
| | - Hanna Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea5Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cindy W Yoon
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Byoung Seok Ye
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Juhee Chin
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seun Jeon
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Yearn Seong Choe
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University, Munich, Germany
| | - David J Werring
- Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, Queen Square, London, England
| | - Michael W Weiner
- Department of Radiology, University of California, San Francisco15Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, California
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Ikeda SI. [Cerebral amyloid angiopathy with familial transthyretin-derived oculoleptomeningeal amyloidosis]. Brain Nerve 2013; 65:831-842. [PMID: 23832986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is caused by the accumulation of amyloid fibrils on vascular walls and is a well-known cause of cerebral hemorrhages in the elderly. This disease manifests as recurrent or multiple simultaneous subcortical hematomas, occasionally leading to fatal hemorrhages. Additionally, it is noteworthy that CAA-related hemorrhages can develop in individuals aged around 50 years. Although a few different amyloid fibril proteins have been isolated from patients with CAA, the most common protein is Aβ, which is also the main component of senile plaques in Alzheimer's disease. Recent studies have suggested that corticosteroid therapy is effective for preventing the recurrence of CAA-related hemorrhages. Hereditary generalized amyloidosis usually manifests as familial amyloid polyneuropathy (FAP), showing severe involvement of peripheral somatic and autonomic nerves. Many variant forms of transthyretin (TTR) with a single amino acid substitution have been identified as causative amyloid precursor proteins in FAP. Moreover, a small number of TTR gene mutations causes a rare phenotype of systemic amyloidosis characterized by preferential deposition of TTR-derived amyloid proteins in the vitreous body in the eye, as well as the leptomeninges and subarachnoidal vessels in the central nervous system (CNS). This disorder is called familial oculoleptomeningeal or leptomeningeal amyloidosis and is characterized clinically by CNS symptoms, including progressive dementia, seizures, ataxia, spastic paresis, and stroke-like episodes. Since the variant forms of TTR in this amyloidosis are derived from the retinal epithelium or choroid plexus, liver transplantation-an effective treatment for FAP-is considered less effective for treating this rare form of TTR-related systemic amyloidosis.
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Affiliation(s)
- Shu-ich Ikeda
- Department of Medicine, Shinshu University School of Menicine, Japan
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Bokura H, Yamaguchi S. [Diagnosis and treatment of brain microbleeds]. Brain Nerve 2013; 65:825-830. [PMID: 23832985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Brain microbleeds (MBs) are represented as low-intensity spotty lesions on T2 *-weighted MR images and are frequently detected in healthy people and not only stroke patients. A recent meta-analysis revealed that MBs were present in 34% of patients with ischemic stroke and 60% with intracerebral hemorrhage, respectively. On the other hand, MBs only occur in approximately 4-6% of subjects without cerebrovascular disease and neurological symptoms. The occurrence of MBs in healthy elderly subjects is associated with advanced age or chronic hypertension. The pathological findings of MBs depend on the region of the brain, in which lobar and deep brain MBs are associated with cerebral amyloid angiopathy and hypertensive vasculopathy, respectively. To prevent stroke, risk factors should be carefully managed in subjects with MBs factors. Since hypertension was also found in all subjects who experienced stroke after presenting with MBs, such patients should be treated with intensive anti-hypertensive medication to prevent subsequent ischemic or hemorrhagic stroke. Additionally, antithrombotic drugs should be carefully used in patients with MBs.
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Affiliation(s)
- Hirokazu Bokura
- Department of Neurology, Shimane Prefectural Central Hospital, Japan
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Ihara M. [Management of cerebral small vessel disease for the diagnosis and treatment of dementia]. Brain Nerve 2013; 65:801-809. [PMID: 23832983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
With the demographic shift in life expectancy inexorably increasing in developed countries, dementia is set to become one of the most important health problems worldwide. In recent years, cerebral small vessel disease (SVD) has received much attention as an important cause of dementia. The reason for this is twofold: firstly, arteriosclerosis (type 1 SVD) is the leading cause of vascular cognitive impairment, and secondly, cerebral amyloid angiopathy (CAA; type 2 SVD) is an almost invariable accompaniment of Alzheimer's disease. SVD is known to induce a variety of pathological changes; for example, type 1 SVD results in lacunar infarction, deep microbleeds, and white matter damage, while type 2 SVD leads to cortical microinfarcts, lobar microbleeds, and white matter damage. SVD is considered a spectrum of abnormalities, with the majority of patients experiencing symptoms from both type 1 and type 2 SVD as the disease progresses. The discouraging results of immunotherapy clinical trials for Alzheimer's disease have shifted the scientific attention from the classical neuron-centric approach towards a novel neurovascular approach. As arteries stiffen with age or with other co-morbid factors such as life-related diseases, amyloid β (Aβ) synthesis becomes upregulated, resulting in the deposition of insoluble Aβ not only in the parenchyma as senile plaques but also in the perivascular drainage pathways as CAA. Therefore, therapeutic strategies such as vasoactive drugs that enhance the patency of this Aβ drainage pathway may facilitate Aβ removal and help prevent cognitive decline in the elderly. Based on this emerging paradigm, clinical trials are warranted to investigate whether a neurovascular therapeutic approach can effectively halt cognitive decline and act as a preemptive medicine for patients at risk of dementia.
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Affiliation(s)
- Masafumi Ihara
- Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Japan
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Yamawaki T, Sakurai K. [Diagnosis and treatment of superficial siderosis]. Brain Nerve 2013; 65:843-855. [PMID: 23832987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Superficial siderosis (SS) is a rare condition in which hemosiderin is deposited on the pial surface of the brain and/or spinal cord. Hemosiderin deposition is the consequence of recurrent or persistent hemorrhage in the subarachnoid space. There are two types of SS. In "classical"-type SS, hypointense MRI signals are observed in the brainstem and cerebellum with diffuse and symmetrical margins. Causes of hemorrhage in the "classical" type include tumor, vascular abnormality, injury, and dural defect. The source of hemorrhage is not apparent in approximately 50% of patients despite extensive examination. In "localized"-type SS, hypointense MRI signals are localized in the cerebral cortex. The most common causes of hemorrhage in the "localized" type are cerebral amyloid angiopathy and/or Alzheimer's disease. Patients with SS usually present with slowly progressive and irreversible cerebellar ataxia, sensorineural hearing loss, and/or myelopathy due to involvement of the acoustic nerve, cerebellum, and spinal cord. T2-weighted imaging (WI) or T2* WI demonstrates characteristic linear low-intensity signals along the surface of the brain and spinal cord. Treatment of SS involves identification and surgical correction of the bleeding source. Deferiprone, which is a lipid-soluble iron chelator that can penetrate the blood-brain barrier, is reportedly effective at improving the clinical symptoms and deposition of hemosiderin. It is thus a hopeful treatment option for SS.
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Tocco P, Moretto G, Bovi P. Cerebral amyloid angiopathy presenting with TIA-like episodes. Can J Neurol Sci 2013; 40:437-438. [PMID: 24340787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Mirsadykov DA, Abdumazhitova MM, Arifzhanov IA. Case report of a "probable" cerebral amyloid angiopathy. Zh Vopr Neirokhir Im N N Burdenko 2013; 77:46-52. [PMID: 23659120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sixty-two year old man was admitted to the department of neurosurgery after stroke episode. CT-scan revealed non-traumatic, non-hypertensive intracerebral hemorrhage in the left temporal lobe; cerebral amyloid angiopathy was suspected. Initially, according to Boston criteria, intracerebral hematoma was interpreted as a result of a "probable" cerebral amyloid angiopathy. Surgical evacuation of the hematoma lead to the partial recourse of speech and cognitive deficit. Four weeks after stroke onset and 3 weeks after surgery CT was performed, which revealed intracerebral hematoma in the right parietal lobe; this fact let to diagnose "probable" cerebral amyloid angiopathy. The second hematoma was evacuated, and surgical treatment together with medical therapy improved patient's quality of life. Treatment strategy for the intracerebral hematomas resulting from cerebral amyloid angiopathy has not been justified yet, which requires further investigations.
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Affiliation(s)
- Andreas Charidimou
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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Loitfelder M, Seiler S, Schwingenschuh P, Schmidt R. Cerebral microbleeds: a review. Panminerva Med 2012; 54:149-160. [PMID: 22801432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cerebral microbleeds (CMBs) are frequent findings in MRI scans of elderly subjects. Depending on the MRI protocols applied 4.7% to 24.4% of community-based subjects show incidental CMBs. The rates reported for various types of ischemic strokes and intracerebral hemorrhages vary between 19.4% and 68.5%. Most studies also demonstrated CMBs in approximately one third of Alzheimer cases. A lobar distribution of CMBs is considered to relate to cerebral amyloid angiopathy, while CMBs located in the basal ganglia or in infratentorial brain regions are thought to relate to hypertensive vasculopathy. Besides age, hypertension, diabetes mellitus, and low serum cholesterol have so far been identified as risk factors for CMBs. Presence of an APOE ε4 allele is the only genetic factor that was consistently shown to increase the risk for CMB development. There are only few longitudinal studies on the predictive value of CMBs. For incident ischemic strokes and intracerebral hemorrhages hazard ratios of 4.48 and 50.2 have been reported. CMBs also doubled the risk for conversion to dementia in MCI patients, and there are indications for CMBs being possible predictors of increased mortality. Given the small number of longitudinal investigations with often small sample sizes the role of CMBs as predictors of disease needs to be further elucidated. CMBs were significantly more common in warfarin-treated stroke patients who developed intracerebral hemorrhages (ICH). These data are cross-sectional. They do not provide enough evidence to consider CMBs as a contraindication for antithrombotic agents in primary and secondary stroke prevention. CMBs are likely to unfavourably affect cognitive functioning. It remains to be determined if direct lesion-related effects are responsible for this finding or if CMBs are sole markers of more extensive tissue damage in the wake of cerebral small vessel disease leading to widespread visible but also non-visible tissue destruction with a high likelihood for cognitive consequences.
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Affiliation(s)
- M Loitfelder
- Department of Neurology, Medical University of Graz, Graz, Austria
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Karbowniczek A, Wierzba-Bobrowicz T, Mendel T, Nauman P. Cerebral amyloid angiopathy manifested as a brain tumour. Clinical and neuropathological characteristics of two cases. Folia Neuropathol 2012; 50:194-200. [PMID: 22773466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
We present two cases (female and male patients, aged 64 and 38, respectively) of focal mass lesions mimicking a brain tumour: one with cognitive function deficit, memory troubles, behavioral changes and left hemiparesis, the other with difficulty in orientation and right hemiparesis. General physical and neurological examinations, laboratory tests and neuroimaging were used to diagnose the cases. Both of them showed nonspecific changes in the brain tissue and the brain tumour was suspected. In the first case MRI scan revealed two pathological masses in the right frontal region and hemorrhagical focus with destructions inside lesions. Second patient's MRI scan revealed a pathological mass at the interface of the left temporal and occipital regions. The neurosurgical procedure was performed. The final diagnosis was established on the basis of neuropathological examination of postoperative material. On light microscopy examination a severe cerebral amyloid angiopathy (CAA) was revealed. Amyloidoma was excluded due to the absence of amorphous material and eosynophylic masses. Tumefactive CAA is a rare condition. These two cases of focal, tumefactive, masslike lesions of diffuse cerebral amyloid angiopathy are reported because of diagnostic dilemmas. In patients with history of memory disfunction, neurological deterioration and different multiple changes observed in CT and MRI scans, such as hemorrhagic infarcts and ischemic cerebral lesions, CAA should be suspected. The imaging findings make a distinction between tumefactive CAA and brain tumours like gliomas difficult. A differential diagnosis of CAA and amyloidoma plays a significant role in a neuropathological examination.
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Abstract
An 86-year-old woman was admitted following generalized seizure. Postictally she showed disturbance of consciousness, right hemiparesis, and right spatial neglect. Brain fluid attenuated inversion recovery (FLAIR) imaging demonstrated mainly left-sided, but asymmetrical, subcortical white matter lesions. On the second day, level of consciousness improved, along with right hemiparesis and right spatial neglect. Electroencephalography displayed mainly α waves and sporadic θ waves without sharp waves. One week later, however, the patient again experienced somnolence and right hemiparesis. FLAIR revealed day-by-day enlargement of white matter lesions. The possibilities of hypoglycemia, hyperammonemia, hypothyroidism, Hashimoto encephalopathy, collagen disease, antineutrophil cytoplasmic antibody-related angiitis, and infection were excluded based on the results of blood biochemistry and cerebrospinal fluid. We initially suspected intravascular lymphoma, so random skin biopsy was performed, but the results were negative. We then suspected cerebral amyloid angiopathy because of the presence of dementia and multiple microbleeds on T(2)* weighted magnetic resonance imaging. Cerebral biopsy revealed amyloid deposition in cortical arterioles and CD3-positive T cells in the perivascular space. Cerebral amyloid angiopathy-related leukodystrophy was therefore diagnosed and immunosuppressive treatment was started. After 14 days of treatment, clinical symptoms and results of FLAIR imaging were significantly improved. When patients display asymmetrical subcortical white matter lesions with microbleeds on T(2)* weighted imaging, amyloid angiopathy-related inflammation should be considered.
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Grèze J, Bouzat P, Grand S, Payen JF, Detante O. [Cerebral amyloid angiopathy is difficult to diagnose in the intensive care unit]. Ann Fr Anesth Reanim 2011; 30:933-936. [PMID: 22040867 DOI: 10.1016/j.annfar.2011.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/22/2011] [Indexed: 05/31/2023]
Abstract
Cerebral amyloid angiopathy is a common cause of intracerebral haemorrhage in elderly patients. The diagnosis of cerebral amyloid angiopathy is based on the Boston criteria combining clinical and radiological criteria with no other cause of intracerebral haemorrhage. We describe the case of a 60-year-old female admitted to the intensive care unit for agitation and spatial disorientation. She had multiple intracerebral haematomas on brain CT scan. Typical cerebral microbleeds using MRI and the absence of other cause of intracerebral haemorrhage argued in favour of the diagnosis of cerebral amyloid angiopathy. The patient outcome was favourable with a discharge from the intensive care unit on day 16.
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Affiliation(s)
- J Grèze
- Pôle anesthésie réanimation, CHU de Grenoble, BP 217, 38042 Grenoble, France
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Hineno A, Ikeda SI. [Cerebral amyloid angiopathy]. Nihon Rinsho 2011; 69 Suppl 8:140-147. [PMID: 22787770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Akiyo Hineno
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine
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