Felwick Richard, Amar Khaled
Department of Medicine for the Elderly, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK.
Med Sci Monit. 2007 Feb;13(2):CS24-6.
BACKGROUND; Cerebral amyloid angiopathy (CAA) is a condition characterized by amyloid deposition in the walls of leptomeningal and cerebral cortical blood vessels. Clinically, CAA results in recurrent lobar haemorrhage that frequently presents with cognitive impairment or recurrent cerebral ischaemic events. CAA is widely believed to b eunder-diagnosed.
An 84 year old patient presented with a history of recurrent unexplained collapses on a background of cognitive impairment. CT imaging of the brain demonstrated several lobar haemorrhages. In the absence of other causes of cerebral haemorrhage, the patient fulfilled the Boston diagnosis criteria for probable CAA.
CAA should be considered in patients with multiple lobar haemorrhages, especially in the presence of cognitive impairment, and in the absence of other causes of cerebral haemorrhage such as trauma, space occupying lesion or a coagulopathy. The diagnosis of CAA is an important one because of the likely implication it has on future management targeted to reducing the future risk of further bleeding.
背景;脑淀粉样血管病(CAA)是一种以软脑膜和大脑皮质血管壁淀粉样沉积为特征的疾病。临床上,CAA导致反复的脑叶出血,常伴有认知障碍或反复的脑缺血事件。人们普遍认为CAA诊断不足。
一名84岁患者,有认知障碍病史,反复出现不明原因的跌倒。脑部CT成像显示有多处脑叶出血。在没有其他脑出血原因的情况下,该患者符合可能的CAA的波士顿诊断标准。
对于有多处脑叶出血的患者,尤其是存在认知障碍且没有其他脑出血原因(如创伤、占位性病变或凝血病)的患者,应考虑CAA。CAA的诊断很重要,因为它可能对旨在降低未来进一步出血风险的未来治疗产生影响。