Katsuyama Yuto, Aida Yasuhiro, Kita Daisuke, Enkaku Fumihide, Hamaguchi Tsuyoshi
Department of Neurosurgery, Noto General Hospital, Nanao, Ishikawa, Japan.
Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.
NMC Case Rep J. 2025 Aug 2;12:317-321. doi: 10.2176/jns-nmc.2025-0042. eCollection 2025.
Iatrogenic cerebral amyloid angiopathy is a rare yet clinically relevant condition that may develop decades after cadaveric dura mater transplantation. We present the case of a 48-year-old man who experienced recurrent, bilateral, multilobar intracerebral hemorrhages approximately 40 years after childhood dura mater transplantation. Pathological examination confirmed amyloid β protein deposition around small cerebral blood vessels in the brain parenchyma. Genetic testing excluded mutations associated with hereditary cerebral amyloid angiopathy. According to the patient's operative record, at age 7 years, a left parietal bone tumor and the adjacent dura mater were removed, and a cadaveric dural patch was transplanted onto the intact brain surface. This case suggests that exogenous amyloid β protein can be transmitted through cadaveric dura mater, even when placed on intact brain tissue with preserved glymphatic and dural lymphatic drainage function, manifesting decades after transplantation.
医源性脑淀粉样血管病是一种罕见但具有临床相关性的疾病，可能在尸体硬脑膜移植数十年后发生。我们报告一例48岁男性病例，该患者在儿童时期进行硬脑膜移植后约40年出现复发性、双侧、多叶性脑内出血。病理检查证实脑实质内小脑血管周围有β淀粉样蛋白沉积。基因检测排除了与遗传性脑淀粉样血管病相关的突变。根据患者的手术记录，患者7岁时切除了左顶骨肿瘤及相邻硬脑膜，并将一块尸体硬脑膜补片移植到完整的脑表面。该病例表明，外源性β淀粉样蛋白可通过尸体硬脑膜传播，即使放置在具有完整类淋巴系统和硬脑膜淋巴引流功能的完整脑组织上，也会在移植数十年后显现出来。
