Amyloid-β (Aβ)-Related Cerebral Amyloid Angiopathy Causing Lobar Hemorrhage Decades After Childhood Neurosurgery.

2022

Kellie, Jeremy F

Campbell, Bruce C V

Watson, Rosie

Praeger, Adrian J

Nair, Girish

Murugasu, Anand

Rowe, Christopher C

Masters, Colin L

Collins, Steven

McLean, Catriona

Yassi, Nawaf

Alzheimer disease

Lyodura

cerebral amyloid angiopathy

cerebral hemorrhage

neurosurgery

Journal Article

0000-0001-9786-3096

0000-0003-3632-9433

0000-0003-0010-6238

0000-0003-3072-7940

0000-0002-5245-6611

0000-0002-0302-5727

0000-0002-0685-0060

0000-0003-3910-2453

10.1161/STROKEAHA.121.038364

Recent reports raise the possibility of cerebral amyloid angiopathy (CAA) leading to intracerebral hemorrhage in young adults following childhood neurosurgery, suggesting transmission of amyloid-β (Aβ) through neurosurgical procedures including dura mater grafting. Parenchymal Aβ deposition, and to a lesser extent tau aggregation, similar to that seen in Alzheimer disease, have also been described. We conducted a database review of 634 consecutive intracerebral hemorrhage patients aged <65 years at a tertiary stroke center over 20 years to identify such patients. We identified 3 patients aged in their thirties who presented with spontaneous lobar intracerebral hemorrhage, with imaging or neuropathology consistent with CAA, and a history of childhood neurosurgery. Two of these patients had undergone a dural repair using cadaveric dura mater (Lyodura). In addition to CAA, both patients had neuropathologically confirmed parenchymal Aβ and tau deposits, characteristic of Alzheimer disease. Our findings support the concept of neurosurgical Aβ transmission but suggest that such cases are rare in standard clinical practice.

link

Stroke 2022-08; 53(8): e369-e374

Stroke