Greenberg S M
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Neurology. 1998 Sep;51(3):690-4. doi: 10.1212/wnl.51.3.690.
This article reviews diagnosis of cerebral amyloid angiopathy (CAA) during life and possible approaches to prevention. A clinical diagnosis of "probable CAA" can be made in patients aged 60 years or older with multiple hemorrhages confined to lobar brain regions and no other cause of hemorrhage. Gradient-echo MRI facilitates diagnosis by showing previous hemorrhages with high sensitivity. This technique can also mark the progression of CAA, as 50% of studied patients developed new petechial hemorrhages during 1.5 years of follow-up. The apolipoprotein E epsilon2 and epsilon4 alleles are associated with increased risk and earlier age of first hemorrhage, but are neither sensitive nor specific for CAA. The major remaining challenges are to develop new markers for the presence of CAA and treatments to block vascular amyloid deposition and vessel breakdown.
本文综述了生前脑淀粉样血管病（CAA）的诊断及可能的预防方法。60岁及以上、脑叶区域多发出血且无其他出血原因的患者可作出“可能CAA”的临床诊断。梯度回波磁共振成像（MRI）通过高灵敏度显示既往出血情况有助于诊断。该技术还可标记CAA的进展，因为在1.5年的随访中，50%的研究患者出现了新的瘀点性出血。载脂蛋白Eε2和ε4等位基因与CAA风险增加及首次出血年龄提前有关，但对CAA既不敏感也不具有特异性。目前仍存在的主要挑战是开发用于检测CAA存在的新标志物以及阻止血管淀粉样沉积和血管破裂的治疗方法。
