期刊论文详细信息
BMC Neurology
Fatal thrombolysis-related intracerebral haemorrhage associated with amyloid-β-related angiitis in a middle-aged patient – case report and literature review
Case Report
Zita Reisz1  Istvan Bodi2  Laszlo K. Sztriha3  Claire Troakes4 
[1] Department of Clinical Neuropathology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK;Department of Clinical Neuropathology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK;London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;Department of Neurology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK;London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;
关键词: Case report;    Amyloid-β-related angiitis;    Amyloid-β;    Cerebral amyloid angiopathy;    Thrombolysis;    Intracerebral haemorrhage;   
DOI  :  10.1186/s12883-022-03029-x
 received in 2022-02-21, accepted in 2022-12-14,  发布年份 2022
来源: Springer
PDF
【 摘 要 】

BackgroundAmyloid-β-related angiitis (ABRA) is a rare complication of cerebral amyloid angiopathy, characterized by amyloid-β deposition in the leptomeningeal and cortical vessels with associated angiodestructive granulomatous inflammation. The clinical presentation is variable, including subacute cognitive decline, behavioural changes, headaches, seizures and focal neurological deficits, which may mimic other conditions. Here, we present a case with fatal thrombolysis-related haemorrhage associated with ABRA in a middle-aged patient.Case presentationA 55-year-old man was admitted to hospital with sudden onset left-sided cheek, arm and hand sensory loss, blurred vision, and worsening headache, with a National Institutes of Health Stroke Scale (NIHSS) score of 3. An acute CT head scan showed no contraindications, and therefore the decision was made to give intravenous thrombolysis. Post-thrombolysis, he showed rapid deterioration with visual disturbances, headache and confusion, and a repeat CT head scan confirmed several areas of intracerebral haemorrhage. No benefit from surgical intervention was expected, and the patient died four days after the first presentation. Neuropathological examination found acute ischemic infarcts of three to five days duration in the basal ganglia, insular cortex and occipital lobe, correlating with the initial clinical symptoms. There were also extensive recent intracerebral haemorrhages most likely secondary to thrombolysis. Furthermore, the histological examination revealed severe cerebral amyloid angiopathy associated with granulomatous inflammatory reaction, consistent with ABRA.ConclusionsPresentation of ABRA in a middle-aged patient highlighted the difficulties in recognition and management of this rare condition. There is emerging evidence that patients with CAA may have increased risk of fatal intracerebral haemorrhages following thrombolysis. This may be further increased by a coexisting CAA-related inflammatory vasculopathy which is potentially treatable with steroid therapy if early diagnosis is made.

【 授权许可】

CC BY   
© Crown 2022

【 预 览 】
附件列表
Files Size Format View
RO202305063907914ZK.pdf 1228KB PDF download
Fig. 1 236KB Image download
Fig. 2 747KB Image download
【 图 表 】

Fig. 2

Fig. 1

【 参考文献 】
  • [1]
  • [2]
  • [3]
  • [4]
  • [5]
  • [6]
  • [7]
  • [8]
  • [9]
  • [10]
  • [11]
  • [12]
  • [13]
  • [14]
  • [15]
  • [16]
  • [17]
  • [18]
  • [19]
  • [20]
  • [21]
  • [22]
  • [23]
  • [24]
  • [25]
  • [26]
  • [27]
  • [28]
  • [29]
  • [30]
  • [31]
  • [32]
  • [33]
  • [34]
  文献评价指标  
  下载次数:4次 浏览次数:2次