Abstract
We report the case of a 38-year-old woman who suffered repeated intracerebral hemorrhages caused by cerebral amyloid angiopathy three decades after an astrocytoma resection with cadaveric dural graft used for closing. Neuroimaging showed extensive left parenchymal hematoma, several microbleeds and frontal and occipital superficial siderosis. Pathology showed blood vessels with deposits stained with Congo Red, suggestive of cerebral amyloid angiopathy. Genetic tests did not reveal any mutation related to hereditary forms of β -amyloid pathology.
Highlights
Cerebral amyloid angiopathy (CAA) is a progressive form of microvascular amyloidosis frequently responsible for recurrent lobar hemorrhages in older patients
This case report highlights the importance of considering cerebral amyloid angiopathy as part of differential diagnosis of lobar intracerebral hemorrhage in young adults, especially in those with a past medical history of neurosurgery and provide new evidence to support that amyloid-β might be transmitted as a prion disease
Described in a patient diagnosed with iatrogenic Creutzfelt-Jakob disease after dural grafting [4], Aβ transmission has been reported in patients without iCJD after neurosurgery [1,2,4,5,6,7]
Summary
Cerebral amyloid angiopathy (CAA) is a progressive form of microvascular amyloidosis frequently responsible for recurrent lobar hemorrhages in older patients. A 38-year-old woman presented with sudden aphasia, right hemianopsia and hemiparesis. Her past medical history included a resection of an astrocytoma at the age of 4, using cadaveric dural graft for closure. Computed Tomography (CT) revealed an acute spontaneous left temporo-parieto-occipital hematoma managed conservatively. Cerebral amyloid angiopathy is an extremely rare pathology in young patients. In this group of patients, humanto-human amyloid-β transmission has been hypothesized, following neurosurgical procedures carried out years before. Case Description: We report the case of a 38-year-old woman who suffered repeated intracerebral hemorrhages caused by cerebral amyloid angiopathy three decades after an astrocytoma resection with cadaveric dural graft used for closing. Genetic tests did not reveal any mutation related to hereditary forms of β -amyloid pathology
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