Iatrogenic Cerebral Amyloid Angiopathy After Cardiac Surgery: Two Case Reports

To alert on the risk of interhuman transmission of β-amyloid (Aβ) pathology leading to cerebral amyloid angiopathy (CAA) after non-neurosurgical procedures, here cardiovascular procedures, using cadaveric dura mater (DM) patches.

We describe 2 patients with a similar medical history of cardiac surgery for transposition of the great vessels and presenting with symptomatic hematomas revealing imaging features of probable CAA according to Boston 2.0 but with early onset.

Both patients lacked hereditary causes of CAA. PET amyloid imaging with ¹⁸F-flutemetamol evidenced diffuse brain amyloidosis, with abnormal Aβ levels in CSF analysis. We propose a diagnosis of iatrogenic CAA after cardiac surgery using cadaveric DM.

These 2 cases add to the growing evidence regarding Aβ transmissibility in humans and remove the confounding factor of neurosurgery. Iatrogenic CAA diagnosis should be considered after exclusion of genetic causes in patients with early-onset clinical and neuroimaging features of CAA. Patient should have evidence of Aβ accumulation in the CNS and a suggestive medical history. Treatments at risk should not be limited to neurosurgery and should namely include cardiovascular procedures with CNS tissues such as cadaveric DM or exposure to cadaveric human growth hormone.