脑淀粉样血管病赵元立（英文）课件.pptVIP

《规范》及指导原则适用于食品药品监管部门对第三类医疗器械批发/零售经营企业经营许可（含变更和延续）的现场核查，第二类医疗器械批发/零售经营企业经营备案后的现场核查，以及医疗器械经营企业的各类监督检查 Cerebral Amyloid Angiopathy脑淀粉样血管病 赵元立 北京天坛医院 What is CAA? amyloid deposition aged (=50-60y) arteries of the cortical, subcortical areas M F in incidence Recurrent, Multiple Hemorrhage Prada et al., J. Neurosci., 2007 Background Cerebral amyloid angiopathy (CAA) - deposition of β-amyloid in the media and adventitia of small- and mid-sized arteries ICH - most recognized result of?CAA Relation with Alzheimer disease Cerebral Amyloid angiopathyTwo-photon projection of a z-series about 150 um deep into the brain of a living 20-mo-old transgenic mouse expressing a mutant human amyloid precursor protein. This animal had amyloid deposits surrounding some cerebral vessels. Brian J. Bacskai, Massachusetts General Hospital, USA Epidemiology United States ~ up to 15% of all ICH 60 up to 50% of nontraumatic lobar ICH 70 ~ 15-20 per 100,000 population / year a series of 400 autopsies: CAA in 18.3% of men 28% of women (age 40-90) a series of 117 confirmed AD: 83% CAA Greenberg SM, Stroke 28 (7): 1418–22 July 1997 Sex and Age Sex maybe more commonly in women incidence of ICH is same Age age related Sporadic ICH occurs 60 Familial CAA at younger ages Icelandic form 30-40, Dutch 50-60 Diagnosis CC headache, vomiting, hemiplegia… PH without hypertension, asymptomatic PE ICH related findings CT/MRI lobar/cortical/subcortical SAH, ventricular hemorrhage 梯度回声MR: sensitive to microhemorrhage Pathology Congo Red(+), Aβ(+) Transaxial T2-weighted gradient-echo MR images show innumerable microhemorrhages predominantly at cerebral gray–white matter junction. Microhemorrhages are not present in basal ganglia, pons, or cerebellum. Large focal hemorrhages are present in bilateral parietal lobe Marisa Kastoff Blitstein AJR 2007; 189:720-725 Guideline for diagnosis Boston Group - Four levels Definite CAA: lobar, cortical, or subcort