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Chapter 1.3 - Chapter

from 1 - Inflammatory Conditions

Published online by Cambridge University Press:  06 October 2022

Anita Arsovska
Affiliation:
University of Ss Cyril and Methodius
Derya Uluduz
Affiliation:
Istanbul Üniversitesi
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Summary

Cerebral Amyloid Angiopathy-related inflammation (CAA-ri) is a rare and sometimes aggressive autoimmune encephalopathy caused by immune reaction directed to the beta-amyloid protein in cerebral small vessels. It has been described in the main cerebral amyloid-related diseases, cerebral amyloid angiopathy (CAA) and Alzheimer’s Disease (AD) as a spontaneous occurrence and a phenomenon triggered by immunological therapy in recent trials for AD. Indeed there are several similarities between the clinic-radiological syndrome described in CAA (CAA-ri) and the neuroradiological phenomenon described in AD patients as Amyloid-Related Imaging Abnormalities (ARIA). CAA-ri is probably underdiagnosed because many CAA patients are elderly and cognitively impaired before CAA-ri occurrence. In some cases a missed diagnosis means a missed possibility of treatment because in its most striking form it is known as steroid-responsive dementia. The clinical expression of CAA-ri is characterized by the acute/subacute onset of neurological symptoms, accompanied by the neuroimaging evidence of cerebral vasogenic edema on FLAIR-MR sequences, and cortical-subcortical microbleeds (MBs) and/or cortical superficial siderosis (CSS) on T2*-weighted gradient echo (T2*-GRE) or susceptibility weighted imaging (SWI). CSS is a marker of CAA included in modified Boston criteria for CAA diagnosis and it represents a neuroradiological sign highly specific of CAA and associated to an even higher ICH risk than MBs. Atypical forms of CAA-RI have also been reported including radiologically isolated CAA-ri, minimally symptomatic CAA-RI, CAA-RI with isolated leptomeningitis, and CAA-RI without MBs. There is a well-defined set of clinic-radiological criteria, validated vs hysto-pathological examination with a sensitivity of 82% and a specificity of 97% for the category of probable CAA-ri. The main differential diagnosis is represented by neoplastic, infectious, or other even more rare causes

Type
Chapter
Information
Rare Causes of Stroke
A Handbook
, pp. 99 - 106
Publisher: Cambridge University Press
Print publication year: 2022

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References

Auriel, E, Charidimou, A, Gurol, E. Validation of clinic-radiological criteria for the diagnosis of cerebral amyloid angiopathy-related inflammation. JAMA Neurol. 2016;73: 197.CrossRefGoogle Scholar
Greenberg, SM, Bacskai, BJ, Hernandez-Guillamon, M. Cerebral amyloid angiopathy and Alzheimer disease – one peptide, two pathways. Nat Rev Neurol. 2020;16: 3042.CrossRefGoogle ScholarPubMed
DiFrancesco, JC, Brioschi, M, Brighina, L, Ruffmann, C, Saracchi, E. Anti-A autoantibodies in the CSF of a patient with CAA-related inflammation: A case report. Neurology. 2011;76: 842844.CrossRefGoogle Scholar
DiFrancesco, C, Touat, M, Caulo, M, Gallucci, M. Recurrence of cerebral amyloid angiopathy-related inflammation: A report of two cases from the ICAβ International Network. J Alzheimers Dis. 2015;46: 10711077.CrossRefGoogle ScholarPubMed
Kinnecom, C, Lev, MH, Wendell, L, Smith, EE. Course of cerebral amyloid angiopathy-related inflammation. Neurology. 2004;68: 14111416.CrossRefGoogle Scholar
Berkowitz, AL, Baker, JM, Miller, JJ, Greenberg, SM. Mystery case: Cerebral amyloid angiopathy-related inflammation. Neurology. 2014;83: 16781679.CrossRefGoogle ScholarPubMed
Chung, KK, Anderson, NE, Hutchinson, D. Cerebral amyloid angiopathy related inflammation: Three case reports and a review. J Neurol Neurosurg Psychiatry. 2011;82: 2026.CrossRefGoogle ScholarPubMed
Corovic, A, Kelly, S, Markus, S. Cerebral amyloid angiopathy associated with inflammation: A systematic review of clinical and imaging features and outcome. Int J Stroke 2018;13(3): 257267.CrossRefGoogle ScholarPubMed
Kang, P, Bucelli, RC, Ferguson, CJ. Teaching neuroimages: cerebral amyloid angiopathy-related inflammation presenting with isolated leptomeningitis. Neurology. 2017;9: e66e67.Google Scholar
Liang, JW, Zhang, W, Sarlin, J. Case of cerebral amyloid angiopathy-related inflammation – is the absence of cerebral microbleeds a good prognostic sign? J Stroke Cerebrovasc Dis. 2015;4: e319e322.CrossRefGoogle Scholar
Renard, D, Wacongne, A, Thouvenot, E. Radiologically isolated cerebral amyloid angiopathy-related inflammation. J Stroke Cerebrovasc Dis. 2017;6: e218e220.CrossRefGoogle Scholar
Banerjee, G, Alvares, D, Bowen, J. Minimally symptomatic cerebral amyloid angiopathy-related inflammation: three descriptive case reports. J Neurol Neurosurg Psychiatr. 2019;90: 113115.CrossRefGoogle ScholarPubMed
Sperling, RA, Jack, CR Jr, Black, SE. Amyloid-related imaging abnormalities in amyloid-modifying therapeutic trials: Recommendations from the Alzheimer’s Association Research Roundtable Workgroup. Alzheimers Dement. 2011;7: 367–85.CrossRefGoogle ScholarPubMed
Ketter, N, Brashear, HR, Bogert, J. Central review of amyloid-related imaging abnormalities in two phase iii clinical trials of bapineuzumab in mild-to-moderate Alzheimer’s disease patients. J Alzheimers Dis. 2017;57(2): 557573.CrossRefGoogle ScholarPubMed
Barakos, J, Sperling, R, Salloway, S, Imaging, MR Features of Amyloid-Related Imaging Abnormalities. Am J Neuroradiol. 2013;34: 19581965.CrossRefGoogle ScholarPubMed
Arrighi, HM, Barakos, J, Barkhof, F, Tampieri, D. Amyloid-related imaging abnormalities-haemosiderin (ARIA-H) in patients with Alzheimer’s disease treated with bapineuzumab: a historical, prospective secondary analysis. J Neurol Neurosurg Psychiatry. 2016;87: 106112.Google ScholarPubMed
Piazza, F, Greenberg, SM, Savoiardo, M. Anti-amyloid β autoantibodies in cerebral amyloid angiopathy-related inflammation: implications for amyloid-modifying therapies. Ann Neurol. 2013;73: 449458.CrossRefGoogle ScholarPubMed
Linn, J, Halpin, A, Demaerel, P, et al. Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy. Neurology. 2010;74(17): 13461350.CrossRefGoogle ScholarPubMed
Wollenweber, FA, Baykara, E, Zedde, M, Gesierich, B. Cortical superficial siderosis in different types of cerebral small vessel disease. Stroke. 2017;48(5): 14041407.CrossRefGoogle ScholarPubMed
Wollenweber, FA, Opherk, C, Zedde, M, Catak, C. Prognostic relevance of cortical superficial siderosis in cerebral amyloid angiopathy. Neurology. 2019;92(8): e792e801.CrossRefGoogle ScholarPubMed
Salvarani, C, Hunder, GG, Morris, JM. Aβ-related angiitis comparison with CAA without inflammation and primary CNS vasculitis. Neurology. 2013;81(18): 15961603.CrossRefGoogle ScholarPubMed
DiFrancesco, JC, Longoni, M Piazza, F. Anti-Aβ autoantibodies in amyloid related imaging abnormalities (ARIA): Candidate biomarker for immunotherapy in Alzheimer’s disease and cerebral amyloid angiopathy. Front Neurol. 6: 207.CrossRefGoogle Scholar
Regenhardt, RW, Thon, JM, Das, AS. Association between immunosuppressive treatment and outcomes of cerebral amyloid angiopathy-related inflammation. JAMA Neurol. 2020;22: e201782.Google Scholar
Catak, C, Zedde, M, Malik, R, Janowitz, D, Soric, V. Decreased CSF levels of β-amyloid in patients with cortical superficial siderosis. Front Neurol. 2019;10: 439.CrossRefGoogle Scholar
Piazza, F, Winblad, B. Amyloid-Related Imaging Abnormalities (ARIA) in immunotherapy trials for Alzheimer’s disease: Need for prognostic biomarkers? J Alzheimers Dis. 2016;52(2): 417420.CrossRefGoogle ScholarPubMed
Carmona-Iragui, M, Fernández-Arcos, A, Alcolea, D. Cerebrospinal fluid anti-amyloid-β autoantibodies and amyloid PET in cerebral amyloid angiopathy-related inflammation. J Alzheimers Dis. 2016;50(1): 17.CrossRefGoogle ScholarPubMed
Xu, YY, Chen, S, Zhao, JH, Chen, XL. A case of cerebral amyloid angiopathy-related inflammation with the rare apolipoprotein +2/+2 genotype. Front Neurol. 10: 547.CrossRefGoogle Scholar
Nelson, PT, Pious, NM, Jicha, GA, Wilcock, DM. APOE-+2 and APOE-+4 correlate with increased amyloid accumulation in cerebral vasculature. J Neuropathol Exp Neurol. 2013;2: 708715.CrossRefGoogle Scholar
Marini, S, Crawford, K, Morotti, A, Lee, MJ. Association of apolipoprotein e with intracerebral hemorrhage risk by race/ethnicity: A meta-analysis. JAMA Neurol. 2019;76(4): 480491.CrossRefGoogle ScholarPubMed

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  • Chapter
  • Edited by Derya Uluduz, Istanbul Üniversitesi
  • Anita Arsovska
  • Book: Rare Causes of Stroke
  • Online publication: 06 October 2022
  • Chapter DOI: https://doi.org/10.1017/9781108902793.018
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  • Chapter
  • Edited by Derya Uluduz, Istanbul Üniversitesi
  • Anita Arsovska
  • Book: Rare Causes of Stroke
  • Online publication: 06 October 2022
  • Chapter DOI: https://doi.org/10.1017/9781108902793.018
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Chapter
  • Edited by Derya Uluduz, Istanbul Üniversitesi
  • Anita Arsovska
  • Book: Rare Causes of Stroke
  • Online publication: 06 October 2022
  • Chapter DOI: https://doi.org/10.1017/9781108902793.018
Available formats
×