Abstract Details

Title A Case Report of Hemispheric Cerebral Amyloid Angiopathy After Previous Cadaver Dural Graft

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-019

Objective To report a case of presumed ipsilateral hemispheric cerebral amyloid angiopathy (CAA) after prior cadaver dural graft.

Background CAA is characterized by deposition of amyloid beta in the walls of cortical and leptomeningeal blood vessels. This deposition leads to increased fragility of the blood vessels and in turn recurrent hemorrhage. Recent studies have hypothesized that misfolded amyloid beta protein, like perhaps Creutzfeldt Jakob prions, may propagate in a new host after implantation with affected tissue.

Design/Methods Patient interview and chart review.

Results A 63-year-old man presented with recurrent multifocal right hemispheric lobar hemorrhages. History was notable for severe headaches at 20 years of age, which led to identification of a right frontal cyst resected with a homologous dural graft implant. Pathology of the resected lesion was consistent with an old arteriovenous malformation. He was then asymptomatic for 40 years until he developed left hemiplegia in the setting of an acute right frontal intraparenchymal hemorrhage (remote from area of prior resection), then three years later developed severe headaches in the setting of an acute right parieto-occipital hemorrhage, and subsequently underwent surveillance MRI imaging including susceptibility weighted imaging three months later which demonstrated asymptomatic hemorrhages of the right occipital lobe and right temporoparietal junction. Imaging demonstrated extensive siderosis involving nearly the entirety of the right cerebral hemisphere with sparing of the left hemisphere most consistent with CAA. CSF studies were positive for Alzheimer’s biomarkers (elevated p-Tau/Abeta42 ratio) but was otherwise unremarkable. APOE testing was e3/e3 (which is not associated with vasculopathy). Conventional angiogram was unremarkable and demonstrated no underlying cerebrovascular abnormality.

Conclusions Prior surgery with cadaver grafts may be a rare risk factor for the development of CAA. This case suggests that there may be direct seeding of amyloid beta from donor tissue and thus may provide insight into the pathophysiology of CAA.

Authors/Disclosures
Stephanie Syc-Mazurek, MD, PhD (Mayo Clinic) PRESENTER	Dr. Syc-Mazurek has a non-compensated relationship as a Editorial Board Resident and Fellows Section with Neurology that is relevant to AAN interests or activities.
Alejandro A. Rabinstein, MD, FAAN (Mayo Clinic)	Dr. Rabinstein has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Shionogi . Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chiesi. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceribell. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical care/NCS-Springer. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters/UptoDate. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO/DynaMed. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care.
Deena Nasr, DO (Mayo Clinic)	Dr. Nasr has nothing to disclose.

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