Research reportImpaired dynamic cerebral autoregulation in patients with cerebral amyloid angiopathy
Section snippets
Introduction:
Cerebral amyloid angiopathy (CAA) is a major cause of intracerebral hemorrhage in the elderly (Banerjee et al., 2017). Accumulation of Amyloid β in cerebral arterioles characterizes the histopathology of the disease (Gahr et al., 2013). The pathophysiological link to the increased risk of cerebral hemorrhage, starting from micro- to macrovascular and subarachnoid sulcal hemorrhages, seems to be degradation of small vessels but perhaps also impairment of vasoregulation. Of interest, the risk of
Results
We included 15 patients and 14 controls in the final analysis. One control person had to be excluded because of previously-unknown severe cerebral small vessel disease (SVD) on brain MRI performed within the study.
Analysis of MRI scans performed within the study showed typical lobar microbleeds in all patients and in none of the control group. Within the patient group, 4 of 15 patients also showed multiple microbleeds in the basal ganglia, resulting in classification as mixed microbleeds.
Discussion
In this study we found that dynamic characteristics of cerebral autoregulation are impaired in patients with CAA and that the extent of autoregulatory impairment associates with the degree of microbleeds.
There are no previous studies on autoregulation of cerebral blood flow in CAA. The mechanism of neurovascular coupling was impaired in the PCA in patients with CAA, while cerebrovascular reactivity to hypercapnia was unaltered in the MCA in patients with CAA (Dumas et al., 2012, Smith et al.,
Methods and materials
Within a prospective observational study we included 15 patients according to the following inclusion criteria: 1. At least “probable” CAA according to Boston criteria (≥2 hemorrhages – including microbleeds on brain MRI, age ≥ 55 yrs, absence of other causes of hemorrhage, typical history) (van Rooden et al., 2009). 2. Absent history of non-lacunar ischemic stroke 3. No recent cerebral hemorrhage or any other neurological event within the previous 90 days. 4. Absence of stenosis >50% of brain
Disclosure
None of the authors received any financial compensation for their contribution to this study. There are no conflicts of interest.
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