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Povzetek: Background: Cerebral amyloid angiopathy (CAA) is an age-related condition marked by amyloid-β (Aβ) accumulation in the small cerebral vessels. Iatrogenic cerebral amyloid angiopathy (iCAA) is a distinct form of CAA in younger patients with a history of cranial surgeries involving cadaveric dural transplants. Both iCAA and CAA are linked to recurrent lobar intracerebral hemorrhage (ICH). This article highlights iCAA as a distinct variant, discussing the possibility of using simplified Edinburgh computed tomography (CT) criteria as a possible diagnostic tool for CAA and carefully considering plausible childhood surgery, with the risk of Aβ transmission through dural grafts in all, especially middle-aged patients. Case Description: We present two cases of iCAA in a 46-year-old female and a 52-year-old male who suffered recurrent spontaneous lobar ICHs. The CAA was diagnosed using the simplified Edinburgh CT criteria, leading to further investigations into the underlying pathology. Based on their age, iCAA was suspected, and only after a meticulous search of the hospital documentation it was discovered that they both underwent cranial surgeries in childhood involving cadaveric dural grafts. The diagnosis of iCAA was established using the proposed diagnostic criteria by Banerjee et al. and later confirmed by pathological examination. Conclusion: Our paper emphasizes the simplified Edinburgh criteria as a potential yet preliminary diagnostic tool for iCAA, while also highlighting the long-term risks of iatrogenic amyloid transmission related to dural grafting following various neurosurgical procedures.
Ključne besede: amyloid-ß proteins, cadaveric, cerebral amyloid angiopathy, dural allotransplants, Edinburgh criteria, iatrogenic, intracerebral hemorrhage, lobar, prion-like transmission, recurrent, simplified, spontaneous
Objavljeno v DiRROS: 09.03.2026; Ogledov: 59; Prenosov: 29
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Povzetek: Cerebral hyperperfusion syndrome (CHS) is a serious post-procedural complication of carotid artery stenting (CAS). The pathophysiological mechanisms of CHS in the absence of arterial hypertension (AH) remain only partially understood. We performed a systematic literature search of the PubMed database using the terms »cerebral hyperperfusion syndrome«, »hypotension«, »hyperperfusion«, »stroke«, »intracranial hemorrhages«, »risk factors«, »carotid revascularization«, »carotid stenting«, »carotid endarterectomy«, »blood-brain barrier«, »endothelium«, »contrast encephalopathy«, and combinations. We present a case of a normotensive female patient who developed CHS post-CAS for symptomatic carotid stenosis while being hypotensive with complete recovery. We identified 393 papers, among which 65 were deemed relevant to the topic. The weighted average prevalence of CHS after CAS is 1.2% [0.0–37.7%] with that of intracranial hemorrhage (ICH) being 0.51% [0–9.3%]. Recently symptomatic carotid stenosis or contralateral carotid revascularization, urgent intervention, acute carotid occlusion, contralateral ≥70% stenosis, and the presence of leptomeningeal collaterals were associated with CHS. A prolonged hemodynamic instability after CAS conveys a higher risk for CHS. However, none of the articles mentioned isolated hypotension as a risk factor for CHS. Whereas mortality after ICH post-CAS ranges from 40 to 75%, in the absence of ICH, CHS generally carries a good prognosis. AH is not obligatory in CHS development. Even though impaired cerebral autoregulation and post-revascularization changes in cerebral hemodynamics seem to play a pivotal role in CHS pathophysiology, our case highlights the complexity of CHS, involving factors like endothelial dysfunction and sudden reperfusion. Further research is needed to refine diagnostic and management approaches for this condition.
Ključne besede: carotid artery stenting, cerebral autoregulation, cerebral hyperperfusion syndrome, endothelial dysfunction
Objavljeno v DiRROS: 13.01.2026; Ogledov: 263; Prenosov: 146
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Povzetek: Due to the diversity of underlying factors and the absence of a uniform treatment approach, diagnosis and management of patients with cerebral venous sinus thrombosis (CVST) remain a challenging task.1 CVST represents 0.5% to 1% of all strokes and affects approximately 5 patients per million every year, but has a higher frequency among younger patients. Typical acquired risk factors include recent surgery, trauma, pregnancy, postpartum state, antiphospholipid syndrome, cancer and use of oral contraceptives. Cases of inherited thrombophilia include Antithrombin III, Protein C and Protein S deficiency, factor V Leiden positivity, prothrombin gene mutation and hyperhomocisteinemia. Infection of parameningeal spaces (ears, paranasal sinuses, oral cavity, face and neck) is common cause of CVST in pediatric population but rare in adults. The symptoms of CVST are not specific. The most common complaint is headache which occurs in up to 90% of patients. Additionally, abnormal vision, any of the symptoms of stroke and seizures have been described. In the past D-dimer levels appeared to be of value as an initial screening test. A study in 2004 evaluated the sensitivity of D-dimer to be 97.1% and specificity 99.1%.8 However, later studies showed that up to 10% of patients with CVST have a normal D-dimer. As it is fast, affordable and widely available, non-contrast computed tomography (NCCT) is the most frequently performed imaging study for evaluation of patients with new headache, focal neurological abnormalities, seizure, or change in mental status. A typical imaging finding in patients with CVST is direct visualization of a hyperattenuating thrombus in the occluded sinus (dense sinus sign). Occasionally, NCCT may only show indirect signs of thrombosis, including diffuse brain edema and parenchymal hemorrhage. Sensitivity of NCCT in the diagnosis of CVST was previously considered rather poor. However, using modern multidetector row CT scanners, recent studies report higher sensitivity and specificity values. In addition, Buyck et al. suggest measurement of the venous sinus attenuation to increase the diagnostic yield of the examination. Therefore, the goal of the present study was to evaluate the diagnostic accuracy of NCCT in the diagnosis of CVST in the emergency setting
Ključne besede: cerebral venous sinus thrombosis, computed tomography, stroke, radiologija, računalniška tomografija, diagnostika, možganski venski sinusi
Objavljeno v DiRROS: 09.05.2024; Ogledov: 1215; Prenosov: 734
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