Amyloid-β (Aβ)-Related Cerebral Amyloid Angiopathy Causing Lobar Hemorrhage Decades After Childhood Neurosurgery

• Published in: Stroke (1970) Vol. 53; no. 8; pp. e369 - e374
• Main Authors: Kellie, Jeremy F., Campbell, Bruce C.V., Watson, Rosie, Praeger, Adrian J., Nair, Girish, Murugasu, Anand, Rowe, Christopher C., Masters, Colin L., Collins, Steven, McLean, Catriona, Yassi, Nawaf
• Format: Journal Article
• Language: English
• Published: 01.08.2022
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.121.038364

Background: Recent reports raise the possibility of cerebral amyloid angiopathy (CAA) leading to intracerebral hemorrhage in young adults following childhood neurosurgery, suggesting transmission of amyloid-β (Aβ) through neurosurgical procedures including dura mater grafting. Parenchymal Aβ deposition, and to a lesser extent tau aggregation, similar to that seen in Alzheimer disease, have also been described. Methods: We conducted a database review of 634 consecutive intracerebral hemorrhage patients aged <65 years at a tertiary stroke center over 20 years to identify such patients. Results: We identified 3 patients aged in their thirties who presented with spontaneous lobar intracerebral hemorrhage, with imaging or neuropathology consistent with CAA, and a history of childhood neurosurgery. Two of these patients had undergone a dural repair using cadaveric dura mater (Lyodura). In addition to CAA, both patients had neuropathologically confirmed parenchymal Aβ and tau deposits, characteristic of Alzheimer disease. Conclusions: Our findings support the concept of neurosurgical Aβ transmission but suggest that such cases are rare in standard clinical practice.