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Long-term hemodynamic changes in cerebral proliferative angiopathy presenting with intracranial hemorrhage:

Takaya Saito, Kei Harada, Masahito Kajihara

    Journal of Neurosurgery. Case Lessons
    |April 18, 2023
    PubMed

    Insights

    This case study tracks cerebral proliferative angiopathy (CPA) over 20 years, detailing hemodynamic changes and successful endovascular treatment of a ruptured aneurysm. It highlights CPA

    Area of Science:

    • Neurology
    • Vascular Medicine
    • Radiology

    Background:

    • Cerebral proliferative angiopathy (CPA) is a rare vascular condition with limited long-term follow-up data.
    • This report details a unique 20-year case history of a patient diagnosed with CPA.

    Purpose of the Study:

    • To document the long-term clinical course and hemodynamic changes in a patient with cerebral proliferative angiopathy (CPA).
    • To illustrate the diagnostic utility of angiography and SPECT in monitoring CPA progression.
    • To report the successful endovascular treatment of a ruptured aneurysm in a CPA patient.

    Main Methods:

    • Longitudinal case study over 20 years.
    • Diagnostic imaging including angiography and Single-Photon Emission Computed Tomography (SPECT) to assess cerebral blood flow (CBF).
    • Intervention involved coil embolization of a ruptured aneurysm using advanced endovascular techniques.

    Main Results:

    • Initial presentation at age 5 with hemorrhage; diagnosis of CPA confirmed at age 25 with evidence of lesion enlargement and hemodynamic changes.
    • SPECT revealed significant decreases in CBF within the CPA nidus and surrounding areas over time.
    • Successful coil embolization of a ruptured aneurysm originating from the lateral posterior choroidal artery, with no new aneurysms noted post-procedure.

    Conclusions:

    • This is the first report demonstrating 17-year hemodynamic alterations in CPA using angiography and SPECT.
    • Endovascular advancements facilitate the treatment of ruptured peripheral cerebral artery aneurysms in CPA.
    • The study underscores the importance of long-term monitoring and advanced interventional radiology for managing rare vascular diseases like CPA.
    Abstract

    Keywords:
    coil embolizationendovascular treatmentflow-related aneurysmproliferative angiopathy

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