Tanaka Fumine, Umino Maki, Matsukawa Megumi, Kishi Seiya, Kogue Ryota, Kawada Norikazu, Kagawa Ken, Utsunomiya Takaya, Kajikawa Hiroyuki, Ishikawa Hidehiro, Ii Yuichiro, Shindo Akihiro, Sakuma Hajime, Maeda Masayuki
Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu 514-8507, Mie, Japan.
Department of Radiology, Matsusaka Chuo General Hospital, Matsusaka 515-0818, Mie, Japan.
Neurol Int. 2025 Apr 24;17(5):64. doi: 10.3390/neurolint17050064.
: A subtype of cerebral amyloid angiopathy (CAA), iatrogenic CAA (iCAA), has been increasingly reported. iCAA occurs primarily in patients who underwent surgery during childhood and is caused by the prion-like propagation of amyloid beta. This subtype of CAA tends to develop at a younger age than age-related CAA, usually before the age of 55. After a latency period of 20-40 years following surgery, it manifests as lobar intracerebral hemorrhage (ICH), cognitive impairment, or transient focal neurological episodes. Between 2023 and 2024, we observed four cases of possible iCAA, all of which had a history of neurosurgery during childhood. : MRI findings for all cases revealed multiple lobar microbleeds. Two cases also showed cortical superficial siderosis and lobar ICH. Notably, contrast-enhanced 3D FLAIR demonstrated sulcal enhancement in two cases, and CT demonstrated cortical calcification in the bilateral posterior lobes in one case. : Sulcal enhancement on contrast-enhanced 3D FLAIR and cortical calcification in the bilateral posterior lobes on CT may suggest advanced CAA in the present cases.
医源性脑淀粉样血管病（iCAA）作为脑淀粉样血管病（CAA）的一种亚型，其报道日益增多。iCAA主要发生在童年时期接受过手术的患者中，由淀粉样β蛋白的朊病毒样传播引起。与年龄相关的CAA相比，这种CAA亚型往往在更年轻的时候发病，通常在55岁之前。在手术后20 - 40年的潜伏期后，表现为脑叶脑出血（ICH）、认知障碍或短暂性局灶性神经发作。在2023年至2024年期间，我们观察到4例可能的iCAA病例，所有病例均有童年时期神经外科手术史。所有病例的MRI表现均显示多发脑叶微出血。2例还显示皮质表面铁沉积和脑叶ICH。值得注意的是，对比增强3D FLAIR显示2例有脑沟强化，CT显示1例双侧后叶皮质钙化。对比增强3D FLAIR上的脑沟强化和CT上双侧后叶皮质钙化可能提示本病例中存在晚期CAA。
