Iatrogenic Cerebral Amyloid Angiopathy After Cardiac Surgery: Two Case Reports

Area of Science:

• Neurology
• Pathology
• Medical Procedures

Background:

• Beta-amyloid (Aβ) pathology, particularly cerebral amyloid angiopathy (CAA), is increasingly recognized.
• Transmission of Aβ pathology has been linked to neurosurgical procedures.
• The role of non-neurosurgical procedures in Aβ transmission remains less understood.

Purpose of the Study:

• To alert healthcare professionals to the risk of interhuman Aβ transmission via cardiovascular procedures using cadaveric dura mater (DM).
• To report cases of early-onset CAA potentially linked to cardiac surgery.

Main Methods:

• Case study of two patients with early-onset CAA after cardiac surgery.
• Clinical presentation included symptomatic hematomas.
• Diagnostic tools included neuroimaging (Boston 2.0 criteria), PET amyloid imaging (¹⁸F-flutemetamol), and cerebrospinal fluid (CSF) analysis.

Main Results:

• Both patients lacked hereditary causes for CAA.
• Imaging and CSF analysis confirmed diffuse brain amyloidosis and abnormal Aβ levels.
• A diagnosis of iatrogenic CAA secondary to cardiac surgery using cadaveric DM was proposed.

Conclusions:

• These cases support the transmissibility of Aβ pathology in humans, extending beyond neurosurgery.
• Iatrogenic CAA should be considered in early-onset cases with suggestive medical history and confirmed Aβ accumulation.
• Cardiovascular procedures involving CNS tissues or cadaveric human growth hormone are potential iatrogenic risks.