脑淀粉样血管病赵元立英文课件.pptVIP

grading 脑淀粉样血管病 _ 赵元立（英文） 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 angiopathy Two-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(+), A β (+) 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: lob