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Cerebral amyloid angiopathy - The modified Boston criteria in clinical practice
André Caetano1, Filipa Ladeira1, Raquel Barbosa1
1Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua da Junqueira, 126, Lisbon 1349-019, Portugal.
Insights
New criteria for cerebral amyloid angiopathy (CAA) identified more patients, including several on antithrombotic therapy. This highlights the importance of updated diagnostic tools for managing hemorrhage risk.
Area of Science:
- Neurology
- Neuroradiology
- Vascular Neurology
Background:
- Cerebral amyloid angiopathy (CAA) increases cerebral hemorrhage risk.
- Early identification is crucial for patient management.
- Superficial siderosis is a key feature in new CAA diagnostic criteria.
Purpose of the Study:
- To evaluate the impact of new diagnostic criteria for CAA.
- To assess the proportion of CAA patients using antithrombotic therapy.
Main Methods:
- Retrospective review of neurology patients (2014-2016) with hemorrhage or transient focal neurological episodes.
- Inclusion of patients meeting original and modified Boston criteria for CAA.
- Data collection on clinical presentation, imaging, and therapy.
Main Results:
- Modified Boston criteria identified 22 CAA patients, compared to 15 with original criteria.
- An additional 7 patients were identified using the modified criteria.
- Four of these newly identified patients were on antithrombotic therapy.
Conclusions:
- Modified Boston criteria enhance CAA detection, identifying more patients at risk.
- This improved identification has significant clinical implications, particularly regarding antithrombotic use.
- Increased clinician awareness of CAA presentations is vital for effective management.
Background:
Early identification of patients with cerebral amyloid angiopathy (CAA) is relevant considering the increased risk for cerebral hemorrhage. A new set of diagnostic criteria for CAA was recently proposed, which include the presence of superficial siderosis. We aimed to assess the impact of applying these criteria regarding use of antithrombotic therapy.
Methods:
Review of consecutive patients admitted to a Neurology Department from 2014 to 2016, with acute parenchymal or subarachnoid hemorrhage and/or atypical transient focal neurological episodes. Patients with a possible or probable CAA according to the original and modified Boston criteria were included. Information was collected regarding presentation, imaging findings and concomitant therapy.
Results:
Among a total of 1436 admitted patients, 52 with acute hemorrhagic lesions or atypical TFNE were screened: 22 met criteria for CAA; 4 were deemed too young; 21 had other causes for hemorrhagic parenchymal lesions; and 5 had uncertain diagnosis. Using the modified Boston criteria, 8 patients fulfilled criteria for probable CAA and 14 for possible CAA. When we applied the original Boston criteria to the same patients, only 7 fulfilled criteria for probable CAA and 8 for possible CAA. Among the additional patients identified with the modified Boston criteria, 4 were using antithrombotic therapy.
Conclusions:
The use of the modified Boston criteria allowed for the identification of 7 additional patients, more than half of which were taking antithrombotic therapy. Systematic use of these criteria could have an important impact in clinical practice. Raising awareness on the different presentations of CAA among clinicians is of the utmost importance.
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