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Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy

W T Kimberly1, A Gilson, N S Rost

  • 1Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Neurology
|April 8, 2009
PubMed
Abstract

Insights

Cerebral amyloid angiopathy (CAA) is linked to small strokes and hemorrhages. Advanced CAA patients show MRI evidence of subacute infarcts, associated with more hemorrhages but not traditional vascular risks.

Area of Science:

  • Neurology
  • Neuroradiology
  • Cerebrovascular Diseases

Background:

  • Cerebral amyloid angiopathy (CAA) is associated with neuropathologic findings of small ischemic infarctions and hemorrhages.
  • Diffusion-weighted imaging (DWI) detects acute or subacute infarcts, but their prevalence in CAA requires further investigation.

Purpose of the Study:

  • To determine the prevalence of infarcts detected by DWI in patients with probable CAA.
  • To identify risk factors associated with these infarcts in CAA patients.

Main Methods:

  • Retrospective analysis of MRI scans from 78 probable CAA subjects and 55 Alzheimer disease or mild cognitive impairment (AD/MCI) subjects.
  • Inspection of DWI and apparent diffusion coefficient (ADC) maps for infarcts.
  • Association analysis with demographic variables, vascular risk factors, and radiographic CAA markers (hemorrhages, white matter lesions).

Main Results:

  • 15% of CAA subjects (12/78) exhibited 17 DWI-lesions consistent with subacute cerebral infarctions, compared to 0% in the AD/MCI group (p=0.001).
  • Lesions were predominantly in the cortex and subcortical white matter.
  • CAA subjects with DWI lesions had a higher median number of hemorrhages (22 vs 4, p=0.025) but no significant differences in white matter lesion volume or vascular risk factors.

Conclusions:

  • Subacute cerebral infarcts are detectable by MRI in a significant portion of patients with advanced CAA.
  • The presence of these infarcts correlates with a higher cerebral hemorrhage burden.
  • Advanced CAA may predispose individuals to both ischemic infarction and intracerebral hemorrhage.

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