[Cerebral amyloid angiopathy, comorbid atrial fibrillation].
O A NovosadovaT N SemenovaV N GrigoryevaPublished in: Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova (2021)
Cerebral amyloid angiopathy (CAA) is caused by the deposition of β-amyloid in small vessels in the cerebral cortex and leptomeninges. Nowadays, CAA is recognized more often due to the development of neuroimaging technologies. The frequency of CAA increases in old age that explains its frequent association with cardiovascular diseases. Combination of CAA with atrial fibrillation (AF) causes particular difficulties in managing of the patients, since antithrombotic drugs prescribed to patients with AF mostly contraindicated in CAA because of increased risk of intracerebral hemorrhages. The article presents a case report of the patient with AF who was admitted to the stroke center with acute ischemic stroke. According to MRI, the focus of acute ischemia was small and localized in the cerebellum. This stroke was regarded as having an undetermined etiology according TOAST classification. Small-vessel occlusion subtype was not diagnosed because the TOAST criteria do not attribute an ischemic focus in the cerebellum to a lacunar stroke, while cardioembolic subtype was rejected due to a small (less than 1.5 cm in diameter) size of the focus. Probable CAA in the patient was diagnosed on the basis of the following MRI data: multiple cortical-subcortical micro-hemorrhages (T2*GRE); a single cortical focus with features of the hemorrhage at the stage of intracellular methemoglobin deposition (T1- weighted MR images); bilateral enlargement of perivascular spaces in semioval centers (FLAIR); a negative fronto-occipital gradient (T2-weighted MR images). A diagnosis of CAA was made in accordance with the 2010 Boston criteria and 2019 recommendations of the International CAA Association. The article discusses the hemorrhagic and non-hemorrhagic MRI features of CAA. Frequency of occurrence of cortical microinfarcts in CAA is discussed as well as their differences from small cardioembolic infarcts in AF. Algorithms for antithrombotic therapy for secondary prevention of ischemic stroke in patients with CAA and AF are considered.
Keyphrases
- atrial fibrillation
- contrast enhanced
- oral anticoagulants
- left atrial
- catheter ablation
- left atrial appendage
- direct oral anticoagulants
- deep learning
- heart failure
- magnetic resonance
- magnetic resonance imaging
- acute ischemic stroke
- cardiovascular disease
- cerebral ischemia
- percutaneous coronary intervention
- risk assessment
- newly diagnosed
- subarachnoid hemorrhage
- diffusion weighted imaging
- computed tomography
- case report
- liver failure
- type diabetes
- venous thromboembolism
- coronary artery disease
- patient reported outcomes
- cerebral blood flow
- big data
- data analysis
- cardiovascular events
- electronic health record
- mitral valve
- ischemia reperfusion injury