Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region; Division of Rehabilitation, Department of Medicine, Tung Wah Hospital, Hong Kong Special Administrative Region.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States of America.
J Neuroimmunol. 2024 Sep 15;394:578406. doi: 10.1016/j.jneuroim.2024.578406. Epub 2024 Jul 23.
Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a rapid but reversible autoimmune encephalopathy where spontaneous autoantibody reaction against amyloid beta deposited in cerebral blood vessels produces characteristic neuroinflammatory changes such as vasogenic edema and microhemorrhages on MRI. The term amyloid-related imaging abnormalities (ARIA) is sometimes used to describe these changes but are more often reserved for similar MRI signal abnormalities seen after administration of anti-amyloid immunotherapy, using treatment exposure as an antecedent. It is unclear if there is any biological basis for this dichotomized distinction. We report a case of severe CAA-ri after exposure to SARS-CoV-2 vaccine and performed a literature review of CAA-ri related to vaccination. CAA-ri precipitated by immunogenic triggers other than anti-amyloid therapy would lend support to the hypothesis that ARIA seen on MRI may represent the same disease underpinned by a shared anti-Aβ autoantibody response irrespective of etiology. A thorough history should be taken before labelling CAA-ri as spontaneous.
脑淀粉样血管病相关性炎症（CAA-ri）是一种迅速但可逆转的自身免疫性脑病，其中针对沉积在脑血管中的淀粉样β的自发自身抗体反应产生特征性的神经炎症改变，如 MRI 上的血管源性水肿和微出血。有时使用术语淀粉样相关成像异常（ARIA）来描述这些变化，但更常用于描述抗淀粉样免疫治疗后出现的类似 MRI 信号异常，将治疗暴露作为先前事件。目前尚不清楚这种二分法区分是否有任何生物学基础。我们报告了一例接触 SARS-CoV-2 疫苗后发生严重 CAA-ri 的病例，并对与疫苗接种相关的 CAA-ri 进行了文献复习。除抗淀粉样治疗外，免疫原性触发因素引发的 CAA-ri 将支持这样一种假设，即在 MRI 上看到的 ARIA 可能代表同一种疾病，其基础是由共同的抗 Aβ 自身抗体反应引起的，而与病因无关。在将 CAA-ri 标记为自发性疾病之前，应进行详细的病史采集。
