Nous proposons une synthèse de la littérature concernant l’angiopathie amyloïde cérébrale (AAC) de forme sporadique. L’AAC est causée par. L’angiopathie amyloïde cérébrale (AAC) est une pathologie caractérisée par un dépôt de peptide ß-amyloïde dans les vaisseaux cérébraux. L’angiopathie amyloïde cérébrale (AAC) est une pathologie fréquente du sujet âgé responsable le plus souvent de complications.
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Cerebral amyloid angiopathy CAA involves cerebrovascular amyloid deposition and is classified into several types according to the amyloid protein involved.
Thus, CAA is related to dementia, stroke, and encephalopathies. Recent advances in diagnostic procedures, particularly neuroimaging, have enabled us to establish a clinical diagnosis of CAA without brain biopsies.
Amyloid imaging with amyloid-binding positron emission tomography PET ligands, such as Pittsburgh Compound B, can detect CAA, although they cannot discriminate vascular from parenchymal amyloid deposits. This article reviews CAA and CAA-related disorders with respect to their epidemiology, pathology, pathophysiology, clinical features, biomarkers, diagnosis, treatment, risk factors, and future perspectives.
Cerebral amyloid angiopathy CAA involves cerebrovascular amyloid deposition. CAA was described as a cause of normotensive cerebral hemorrhage in older individuals or also described in studies focusing on its close association with Alzheimer’s disease AD. Currently, CAA has been used as a general term to describe cerebrovascular amyloid deposition or cerebrovascular amyloidosis. CAA is classified into several types according to the amyloid protein involved Table 1.
Pathologically, CAA is observed mainly in the leptomeningeal and cortical vessels of the cerebral lobes and cerebellum. For the distribution of CAA, the occipital lobe is preferentially affected, 6 whereas CAA is uncommon in the basal ganglia, thalamus, brainstem, and white matter.
In mild CAA, a small proportion of the leptomeningeal and superficial cortical vessels are affected with amyloid deposition. In severe CAA, most small arteries and arterioles are affected with marked amyloid deposition.
Medium-sized leptomeningeal arteries show amyloid deposition in the outer regions of the media to the adventitia. Vessel walls of the small arteries and arterioles are often totally replaced by amyloid deposits, except for the endothelial cells. Electron microscopically, amyloid fibrils are focally deposited within the outer basement membrane of the vessels during the initial stage of CAA. In particular, fibrinoid necrosis is closely associated with CAA-related hemorrhage. Massive amyloid deposition of amyloid fibrils with degeneration of smooth muscle cells in the media A.
ANGIOPATHIE AMYLOIDE CEREBRALE AVEC HEMORRAGIE : A PROPOS D’UN CAS
Thickening of the intima arrow and double barreling of vascular walls arrowheads C. Pathophysiology of cerebral amyloid angiopathy CAA -related disorders.
CAA is related to stroke and dementia. Imaging findings of CAA-related hemorrhages and white matter lesions. Fresh arrow and old arrowhead lobar macrohemorrhages in the frontal lobes on CT A.
Cerebral microhemorrhages microbleeds were noted in Studies with amyloid positron emission tomography PET using 11C-Pittsburgh Compound B PiB reported that lobar microhemorrhages are frequently found in PiB-positive healthy subjects as well as patients with AD or mild cognitive impairment MCI33 and that microhemorrhages preferentially occur in local regions of concentrated amyloid deposits.
CAA-related cerebral hypoperfusion or occlusive small-vessel disease may cause progressive white matter lesions and cortical microinfarcts. Impaired vascular angiopathiw in response to visual stimulation or a visual amykoide in CAA was reported in studies with transcranial Doppler ultrasound and functional MRI, consistent with greater distribution of CAA in the angiopathiw lobe. The left parietal region with an old intracerebral hemorrhage shows a relative scarcity of PiB uptake.
The Boston criteria were proposed for the angiopxthie of CAA-related ICH Table 2and high diagnostic accuracy was reported with a small pathologic series. Kanter, MD, Carlos S. Kase, MD, and Michael S.
Cerebral amyloid angiopathy without and with cerebral hemorrhages: When cSS was incorporated into amgiopathie classic Boston criteria the modified Boston criteria Table 2the sensitivity increased from Currently, no disease-modifying therapies are available for CAA.
As for neurosurgery for CAA-related ICH, uncontrollable peri- and post-operative hemorrhages have been reported previously; however, recent studies suggest that neurosurgical procedures, especially hematoma evacuation, can be performed more safely than previously expected. The mean interval between ICHs was Subacute leukoencephalopathy associated with CAA-related inflammation or angiitis was reported to respond to immunosuppressive treatment.
There is increasing evidence that CAA could be a ammyloide factor for ICH with thrombolytic therapies for acute myocardial infarction, pulmonary embolism, or ischemic stroke, and for ICH with warfarin therapies. Vasogenic edema was noted in 2 of 2, patients with AD at the baseline of the clinical trial; findings were compatible with CAA-related inflammation.
A number of studies indicate that the presence of one or more biomarkers plus one or more risk factors suggest the future development of CAA-related disorders. Further prospective studies will establish methods for prediction of CAA-related disorders.
To develop preventive and therapeutic methods for CAA and CAA-related disorders, their molecular pathogenesis needs to be further elucidated. The pathogenesis of CAA-related disorders consists of two angiopathei The cerebrovascular amyloid deposition Step 1 is the primary target of prevention and therapy. Vascular injury secondary to cerebrovascular amyloid deposition Step 2 is an important target for prevention of CAA-related disorders. Risk factors and pathogenic mechanisms underlying vascular injury leading to CAA-related hemorrhages are discussed below.
Cerebral Amyloid Angiopathy: Emerging Concepts
For CAA-related hemorrhages, several non-genetic risk factors have been reported and it is recommended to avoid them. These include thrombolytic, anticoagulation, and anti-platelet therapies, hypertension, and minor head trauma in patients with positive biomarkers of CAA and CAA-related disorders Table 3. Pathogenic mechanisms underlying the damage and rupture of CAA-affected vessels remain to be determined. Pathologically, severe CAA is associated with vasculopathies including loss of smooth muscle cells, duplication “double-barrel” lumenobliterative intimal changes, hyaline degeneration, microaneurysmal dilatation, and fibrinoid necrosis of the vessel walls Figure 1.
The author is grateful to Ms. Etsuko Tsujiguchi for her excellent secretarial anggiopathie.
ANGIOPATHIE AMYLOIDE CEREBRALE AVEC HEMORRAGIE : A PROPOS D’UN CAS (Book, ) 
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. National Center for Biotechnology InformationU.
Journal List J Stroke v. Published online Jan Find articles by Masahito Yamada. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Cerebral amyloid angiopathy CAA involves cerebrovascular amyloid deposition and is classified into several types according to the amyloid protein involved. Introduction Cerebral amyloid angiopathy CAA involves cerebrovascular amyloid deposition.
Table 1 Classification of cerebral amyloid angiopathy CAA. Open in a separate window. Cortical microhemorrhages Cerebral microhemorrhages microbleeds were noted in White matter disease and cortical infarction CAA-related cerebral hypoperfusion or occlusive small-vessel disease may cause progressive white matter lesions and cortical microinfarcts. Functional imaging Impaired vascular reactivity in response to visual stimulation or a visual task in CAA was reported in studies with transcranial Doppler ultrasound and functional MRI, consistent with greater distribution of CAA in the occipital lobe.
Current treatment and prognosis Currently, no disease-modifying therapies are available for CAA. Thrombolytic, anticoagulation, and antiplatelet therapies Ajyloide is amyloidee evidence that CAA could be a risk factor for ICH with thrombolytic therapies for acute myocardial infarction, pulmonary embolism, or ischemic stroke, and for Antiopathie with warfarin therapies. Footnotes The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Die drusige Entartung der Hirnarterien und Kapillaren.
Cerebral Amyloid Angiopathy: Emerging Concepts
Z ges Neurol Psychiat. Yamada Anngiopathie, Naiki H. Prog Mol Biol Transl Sci. Cerebral amyloid angiopathy in the aged. Autopsy study of incidence and distribution of cerebral amyloid angiopathy in Hisayama, Japan.
Risk factors for cerebral amyloid angiopathy in the elderly. Ann N Y Acad Sci. Clinical features of non-hypertensive lobar intracerebral hemorrhage related to cerebral amyloid angiopathy.
Beta amyloid is focally deposited within the outer basement membrane in the amyloid angiopathy of Alzheimer’s disease. An immunoelectron microscopic study. Two types of sporadic cerebral amyloid angiopathy. J Neuropathol Exp Neurol.
Computer-assisted amyloive image analysis of cerebral amyloid angiopathy. Differences between vascular and plaque core amyloid in Alzheimer’s disease. Predicting cerebral amyloid angiopathy-related intracerebral hemorrhages and other cerebrovascular disorders in Alzheimer’s disease.
The association between cerebral amyloid angiopathy and intracerebral haemorrhage: J Neurol Neurosurg Psychiatry. Pathogenetical subtypes of recurrent intracerebral hemorrhage: Intracerebral haemorrhage profiles are changing: Subarachnoid haemorrhage in the elderly: Cerebral amyloid angiopathy as a cause of subarachnoid hemorrhage.
Cerebral microbleeds in Alzheimer’s disease. Amyloidw in Alzheimer disease are more related to cerebral amyloid angiopathy than cerebrovascular disease. Dement Geriatr Cogn Disord. Prevalence and severity of microbleeds in a memory clinic setting. Microbleed topography, leukoaraiosis, and cognition in probable Alzheimer disease angiiopathie the Sunnybrook dementia study.
Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy. Spatial relation between microbleeds and amyloid deposits in amyloid angiopathy. Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy.