cerebral amyloid angiopathy in elderly patient with bleed

  • related: Neurology
  • tags: #literature #neuro #icu

The history of memory loss and new intracerebral hemorrhage in an elderly patient is suggestive of cerebral amyloid angiopathy (CAA) as the cause. This diagnosis is further corroborated by the MRI that does not show an alternate cause for the hemorrhage and shows the microhemorrhages typical of CAA. Because the diagnosis can be confirmed only by means of histological evaluation of brain tissue, definitive diagnosis is uncommon. The pathological mechanism of CAA is buildup of an abnormal protein that aggregates in blood vessels and makes them stiff and friable, which leads to small strokes and hemorrhage. The abnormal protein is not related to the amyloid that leads to cardiac amyloidosis. Occasionally, larger strokes and hemorrhages also occur.

More than the diagnosis, families are often interested in the prognosis and prevention of recurrence. In the case of CAA, however, no intervention has been shown to prevent further strokes, hemorrhages, or progression of dementia. Because hemorrhages in patients with CAA appear to be exacerbated if there is superimposed hypertension, adequate BP control is often recommended. Donepezil is a cholinergic medication that improves memory in patients with mild to moderate dementia. It is not associated with stroke risk. Patients with CAA who enter the hospital with a new event are unlikely to return to their cognitive baseline from before the incident.123

Footnotes

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  2. Gregoire SM, Smith K, Jäger HR, et al. Cerebral microbleeds and long-term cognitive outcome: longitudinal cohort study of stroke clinic patients. Cerebrovasc Dis. 2012;33(5):430-435. PubMed ↩

  3. Kozberg MG, Perosa V, Gurol ME, et al. A practical approach to the management of cerebral amyloid angiopathy. Int J Stroke. 2021;16(4):356-369. PubMed ↩