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Characterizing mixed location hemorrhages/microbleeds with CSF markers.

Ulf Jensen-Kondering1,2, Nils G Margraf3, Caroline Weiler3

  • 1Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany.

International Journal of Stroke : Official Journal of the International Stroke Society
|January 9, 2023
PubMed
Summary

Mixed location hemorrhages (MLH) and cerebral amyloid angiopathy (CAA) may co-occur, suggesting they are part of a disease spectrum. This research clarifies their relationship in elderly patients with brain hemorrhages.

Keywords:
Cerebral amyloid angiopathyamyloid Aß40amyloid Aß42cerebrospinal fluidcortical superficial siderosismixed location hemorrhage/microbleedsmodified Boston criteria

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Area of Science:

  • Neurology
  • Neuroscience
  • Geriatrics

Background:

  • Cerebral amyloid angiopathy (CAA) causes lobar hemorrhages in the elderly, diagnosed by lobar lesions or cortical superficial siderosis (cSS).
  • Hypertensive arteriopathy (HTN-A) causes deep hemorrhages; its presence with lobar lesions defines mixed location hemorrhages (MLH).
  • Distinguishing CAA, MLH, and Alzheimer's disease (AD) is crucial for accurate diagnosis and treatment.

Purpose of the Study:

  • To compare clinical, radiological, and cerebrospinal fluid (CSF) biomarker data in patients with CAA, MLH, AD, and healthy controls (HCs).
  • To determine the position of MLH within the spectrum of cerebrovascular diseases.
  • To investigate the relationship between CAA, MLH, and HTN-A.

Main Methods:

  • Retrospective cohort study of 31 CAA, 31 MLH, 28 AD, and 30 HC patients.
  • Analysis included clinical data, radiological findings, and CSF biomarkers (Aß42, Aß40, t-tau, p-tau).
  • Histopathological data was also analyzed where available.

Main Results:

  • Cortical superficial siderosis (cSS) was more frequent in CAA than MLH (45% vs 13%).
  • CSF biomarker profiles showed HC > MLH > CAA > AD for Aß42 and Aß42/Aß40 ratio, and the reverse for t-tau and p-tau.
  • Lower Aß40/Aß42 levels were observed in CAA and MLH patients with cSS and lacunar infarcts.

Conclusions:

  • MLH and CAA are not mutually exclusive and likely represent points on a disease spectrum.
  • MLH may involve contributions from both CAA and hypertensive arteriopathy (HTN-A).
  • Understanding this spectrum aids in differentiating these common causes of hemorrhage in the elderly.