Editorial Revisado por pares

Intracerebral haemorrhage recurrence in cerebral amyloid angiopathy: Time to look beyond microbleeds?

2016; Elsevier BV; Volume: 367; Linguagem: Inglês

10.1016/j.jns.2016.06.014

ISSN

1878-5883

Autores

Andreas Charidimou, Grégoire Boulouis,

Tópico(s)

Acute Ischemic Stroke Management

Resumo

Cerebral amyloid angiopathy (CAA) is a major cause of spontaneous lobar intracerebral haemorrhage (ICH) in older individuals [ [1] Boulouis G. Charidimou A. Greenberg S.M. Sporadic cerebral amyloid angiopathy: pathophysiology, neuroimaging features, and clinical implications. Seminars in neurology. 2016; 36: 233-243 Crossref PubMed Scopus (35) Google Scholar ]. Accurately predicting the risk of future ICH recurrence in CAA survivors, which is as high as 10–15% per year, is at the cornerstone of clinical care, with important implications for secondary prevention strategies, including antithrombotic drug use and blood pressure management [ [2] Charidimou A. Gang Q. Werring D.J. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum. J. Neurol. Neurosurg. Psychiatry. 2012; 83: 124-137 Crossref PubMed Scopus (395) Google Scholar ]. CAA has been increasingly associated with characteristic MRI markers of small vessel damage which reveal intricate but distinct aspects of the disease process. Among these, the presence of multiple strictly lobar cerebral microbleeds is the most well characterised putative marker of CAA, facilitating diagnosis during life within the validated Boston criteria, and assessment of disease severity and progression [ [3] Pasquini M. Benedictus M.R. Boulouis G. Rossi C. Dequatre-Ponchelle N. Cordonnier C. Incident cerebral microbleeds in a cohort of intracerebral hemorrhage. Stroke. 2016; 47: 689-694 PubMed Google Scholar ]. However, beyond microbleeds, cortical superficial siderosis and MRI-visible perivascular spaces in the centrum semiovale (CSO-PVS) have recently emerged as additional promising neuroimaging signatures of CAA, potentially expanding the spectrum of this, as yet, untreatable disease.

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