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Surgical risk of hemorrhage in cerebral amyloid angiopathy
Z Matkovic1, S Davis, M Gonzales
1Department of Neurology, Royal Melbourne Hospital, Victoria, Australia.
Abstract:
Cerebral amyloid angiopathy is increasingly recognized as a cause of lobar cerebral hemorrhage in normotensive elderly individuals. Isolated reports have suggested that neurosurgical intervention entails a high risk of precipitated hemorrhage. We identified 16 pathologically confirmed cases of cerebral amyloid angiopathy. Fourteen of these patients presented with lobar cerebral hemorrhage. Fifteen neurosurgical procedures in eight patients included eight clot evacuations, three abscess drainage procedures, two ventriculoperitoneal shunts, one biopsy, and one lobectomy. Recurrent postoperative cerebral hemorrhage was seen in four patients at 2 days, 9 days, 6 weeks, and 10 months, but surgery was thought to have precipitated the cerebral hemorrhage in only one patient. Recurrent cerebral hemorrhage also was seen in two of the eight nonoperated cases. Recurrent cerebral hemorrhage is characteristic of cerebral amyloid angiopathy, but we conclude that neurosurgical intervention, particularly evacuation of hematomas, is not associated with major risk of precipitated hemorrhage.
Insights
Neurosurgical intervention for cerebral amyloid angiopathy (CAA) does not significantly increase hemorrhage risk. Recurrent hemorrhages are common in CAA, but surgery is rarely the direct cause.
Area of Science:
- Neurology
- Neurosurgery
- Pathology
Background:
- Cerebral amyloid angiopathy (CAA) is a recognized cause of lobar cerebral hemorrhage in elderly individuals.
- Previous reports suggested high risks associated with neurosurgical intervention in CAA patients.
Purpose of the Study:
- To evaluate the risk of precipitated hemorrhage following neurosurgical intervention in patients with pathologically confirmed cerebral amyloid angiopathy.
Main Methods:
- Retrospective review of 16 pathologically confirmed cases of CAA.
- Analysis of neurosurgical procedures performed on eight patients and outcomes, including recurrent hemorrhages.
Main Results:
- Four of 16 patients experienced recurrent postoperative cerebral hemorrhage.
- Only one case of precipitated hemorrhage was directly attributed to surgery.
- Recurrent hemorrhage also occurred in non-operated patients, indicating it is characteristic of CAA.
Conclusions:
- Neurosurgical intervention, including clot evacuation, is not associated with a major risk of precipitated hemorrhage in cerebral amyloid angiopathy.
- Recurrent hemorrhage is a known complication of CAA, irrespective of surgical intervention.