Review
Clinical Neurology
Konark Malhotra, Christina Zompola, Aikaterini Theodorou, Aristeidis H. Katsanos, Ashkan Shoamanesh, Himanshu Gupta, Simon Beshara, Nitin Goyal, Jason Chang, Ashis H. Tayal, Efstathios Boviatsis, Konstantinos Voumvourakis, Charlotte Cordonnier, David J. Werring, Andrei V. Alexandrov, Georgios Tsivgoulis
Summary: Among patients with spontaneous intracerebral hemorrhage, approximately 1 in 4 cases have undetermined etiology, leading to a relatively high short-term mortality rate. Cerebral amyloid angiopathy accounts for the largest hemorrhage volume, while hypertensive arteriopathy and undetermined ICH have smaller volumes.
Review
Clinical Neurology
Konark Malhotra, Aikaterini Theodorou, Aristeidis H. Katsanos, Christina Zompola, Ashkan Shoamanesh, Efstathios Boviatsis, George P. Paraskevas, Martha Spilioti, Charlotte Cordonnier, David J. Werring, Andrei Alexandrov, Georgios Tsivgoulis
Summary: Limited data exist regarding the prevalence of clinical and neuroimaging manifestations among patients diagnosed with cerebral amyloid angiopathy (CAA). In this study, a systematic review and meta-analysis were conducted, revealing that approximately half of CAA patients have cerebral microbleeds, cortical superficial siderosis, mild cognitive impairment, dementia, intracerebral hemorrhage (ICH), or transient focal neurological episodes. Cortical superficial siderosis was the only neuroimaging marker associated with higher odds of ICH recurrence.
Article
Clinical Neurology
Joan Marti-Fabregas, Pol G. Camps-Renom, Jonathan G. Best, Anna Ramos-Pachon, Marina Guasch-Jimenez, Alejandro Martinez-Domeno, Daniel M. Guisado-Alonso, Beatriz M. Gomez-Anson, Gareth Ambler, Duncan Wilson, Keon-Joo Lee, Jae-Sung Lim, Hee-Joon Bae, Masayuki Shiozawa, Masatoshi Koga, Kazunori G. Toyoda, Michael G. Hennerici, Hugues Chabriat, Eric Jouvent, Debbie Yuen Kwun Wong, Henry Mak, Kui Kai Lau, Young Dae Kim, Tae-Jin Song, Ji-Hoe Heo, Sebastian Eppinger, Thomas Gattringer, Ender Uysal, Derya Selcuk Demirelli, Natan Bornstein, Einor Ben Assayag, Hen A. Hallevi, Jeremy A. Molad, Masashi Nishihara, Jun Tanaka, Hideo Hara, Yusuke B. Yakushiji, Shelagh B. Coutts, Eric A. Smith, Alexandros A. Polymeris, Benjamin Wagner, David A. Seiffge, Philippe A. Lyrer, Nils T. Peters, Stefan T. Engelter, Rustam Al-Shahi Salman, Hans Rudolf Jager, Gregory Y. H. Lip, Martina Goeldlin, Leonidas Panos, Christopher Charles G. Karayiannis, Thanh G. K. Phan, Velandai K. Srikanth, Nicolas Christ, Sarah Gunkel, Felix W. Fluri, Thomas W. Leung, Yannie O. Y. Soo, Winnie Chu, Jill Abrigo, Carmen Barbato, Simone Browning, Robert Simister, Anne-Marie Mendyk, Regis Bordet, Saima Hilal, Bibek Gyanwali, Christopher Chen, Simon Jung, Dilek Necioglu Orken, David Werring, Luis Prats-Sanchez
Summary: This study aimed to investigate the risk of future cerebrovascular events in patients with ischemic stroke (IS) or transient ischemic attack (TIA) and cortical superficial siderosis (cSS), as well as the benefits and safety of antithrombotic drugs for secondary prevention. The study found that cSS was associated with an increased risk of stroke, and the risk of IS was higher than that of intracranial hemorrhage (ICrH) in patients receiving antiplatelet or anticoagulant treatment alone, while the risk of ICrH was higher than that of IS in patients receiving both treatments. Therefore, the study suggests that using antiplatelet or anticoagulant drugs alone is safe in patients with cSS, but combined antithrombotic therapy might be hazardous.
Article
Clinical Neurology
Bo-Ching Lee, Hsin-Hsi Tsai, Chia-Ju Liu, Ya-Fang Chen, Li-Kai Tsai, Jiann-Shing Jeng, Ruoh-Fang Yen
Summary: This study found that cerebral venous reflux (CVR) is more closely associated with cerebral amyloid angiopathy (CAA) than hypertensive microangiopathy in intracerebral hemorrhage (ICH) survivors. The results suggest that venous drainage dysfunction potentially plays a role in CAA and cerebral amyloid deposition.
Article
Neurosciences
Claire Muller
Summary: Recently, there has been increased recognition of iatrogenic cerebral amyloid angiopathy (iCAA) cases globally. This case study examines the clinicoradiological features of a probable iCAA case in Australia, with extensive history documentation and MRI data spanning two decades. The study highlights the aggressive course and early disease manifestations of iCAA, providing insights for the more commonly seen sporadic cases.
FRONTIERS IN NEUROSCIENCE
(2023)
Review
Clinical Neurology
Sarah N. N. Ohashi, Jonathan H. H. DeLong, Mariel G. G. Kozberg, David J. J. Mazur-Hart, Susanne J. J. van Veluw, Nabil J. J. Alkayed, Lauren H. H. Sansing
Summary: Hemorrhagic stroke is the deadliest form of stroke and includes the subtypes of intracerebral hemorrhage and subarachnoid hemorrhage. Inflammatory immune responses play a crucial role in the pathophysiology of these types of stroke, both affecting tissue recovery and injury. Understanding these processes can lead to the development of effective therapeutic strategies.
Article
Neurosciences
Mengke Zhang, Ruiwen Che, Wenbo Zhao, Hailiang Sun, Changhong Ren, Jin Ma, Wenbo Hu, Milan Jia, Chuanjie Wu, Xin Liu, Xunming Ji
Summary: This study aimed to explore the relationship between computed tomography (CT)-based cerebral small vessel disease (SVD) markers and the clinical outcomes in patients with cerebral amyloid angiopathy (CAA)-related intracerebral hemorrhage (ICH). The results showed that the SVD markers based on CT could predict the short-term outcome more effectively in patients with CAA-ICH. Further studies are needed to validate these findings and identify modifiable factors for preventing CAA-ICH development.
CNS NEUROSCIENCE & THERAPEUTICS
(2023)
Article
Clinical Neurology
Jeremy F. Kellie, Bruce C. Campbell, Rosie Watson, Adrian J. Praeger, Girish Nair, Anand Murugasu, Christopher C. Rowe, Colin L. Masters, Steven Collins, Catriona McLean, Nawaf Yassi
Summary: Recent reports suggest the possibility of neurosurgical transmission of cerebral amyloid angiopathy (CAA), leading to intracerebral hemorrhage in young adults. However, such cases are rare in standard clinical practice.
Article
Clinical Neurology
Alvin S. Das, Robert W. Regenhardt, Elif Gokcal, Mitchell J. Horn, Nader Daoud, Kristin M. Schwab, Natalia S. Rost, Anand Viswanathan, W. Taylor Kimberly, Joshua N. Goldstein, Alessandro Biffi, Lee H. Schwamm, Jonathan Rosand, Steven M. Greenberg, M. Edip Gurol
Summary: The study found that approximately one-third of IP-IVH patients had cerebral amyloid angiopathy, and 23% had hypertensive small vessel disease. This suggests that both types of small vessel diseases may be associated with IP-IVH.
INTERNATIONAL JOURNAL OF STROKE
(2022)
Article
Clinical Neurology
Sabine Voigt, Siham Amlal, Emma A. Koemans, Ingeborg Rasing, Ellis S. van Etten, Erik W. van Zwet, Mark A. van Buchem, Gisela M. Terwindt, Marianne A. A. van Walderveen, Marieke J. H. Wermer
Summary: The study investigated the topographical and temporal patterns of index and recurrent intracerebral hemorrhages in Dutch-type hereditary Cerebral Amyloid Angiopathy (D-CAA). Results showed a preference for occipital lobe in both index and recurrent ICHs, with no acceleration in time nor gradual increase of hematoma volume between subsequent ICHs.
INTERNATIONAL JOURNAL OF STROKE
(2022)
Editorial Material
Clinical Neurology
Chloe A. Mutimer, Charithani B. Keragala, Hugh S. Markus, David J. Werring, Geoffrey C. Cloud, Robert L. Medcalf
Summary: Cerebral amyloid angiopathy is a devastating cause of intracerebral hemorrhage with no specific secondary stroke prevention treatment available. Tranexamic acid is postulated as a potential secondary stroke prevention treatment agent for sporadic cerebral amyloid angiopathy, but further research is needed to confirm this.
Article
Clinical Neurology
Ingeborg Rasing, Sabine Voigt, Emma A. Koemans, Erik van Zwet, Paul C. de Kruijff, Thijs W. van Harten, Ellis S. van Etten, Sanneke van Rooden, Louise van der Weerd, Mark A. van Buchem, Matthias J. P. van Osch, Steven M. Greenberg, Marianne A. A. van Walderveen, Gisela M. Terwindt, Marieke J. H. Wermer
Summary: Cortical calcifications are common in Dutch-type hereditary CAA (D-CAA) but rare in sporadic CAA. These calcifications are associated with the development of intracerebral hemorrhage (ICH) and may serve as a marker for advanced CAA. Additionally, there seems to be a link between cortical calcifications on computed tomography and the striped occipital cortex on 7T-magnetic resonance imaging.
Article
Clinical Neurology
Aayushi Garg, Santiago Ortega-Gutierrez, Mudassir Farooqui, Nandakumar Nagaraja
Summary: This study found that patients with intracerebral hemorrhage (ICH) and concomitant cerebral amyloid angiopathy (CAA) are three times more likely to have readmissions for recurrent ICH compared to patients without CAA.
JOURNAL OF NEUROLOGY
(2022)
Review
Biochemistry & Molecular Biology
Yasuteru Inoue, Yukio Ando, Yohei Misumi, Mitsuharu Ueda
Summary: Cerebral amyloid angiopathy (CAA) is characterized by the accumulation of amyloid beta (Aβ) in brain vessels, leading to vessel fragility, hemorrhages, and neurological symptoms. The pathogenesis of CAA is not fully understood, but recent advances in mass spectrometric methodology have identified potential key molecules associated with CAA. Understanding the interactions between cerebrovascular Aβ deposits and these molecules may lead to the development of effective CAA therapeutics.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2021)
Article
Clinical Neurology
Jean-Claude Baron, Ulf Jensen-Kondering, Simona Sacco, Sacha Posener, Joseph Benzakoun, Johan Pallud, Catherine Oppenheim, Pascale Varlet, Guillaume Turc
Summary: Lobar hematomas are common and have high mortality and morbidity. Distinguishing between hypertensive arteriolopathy (HA) and cerebral amyloid angiopathy (CAA) is important. Current diagnostic criteria for probable CAA have limitations, and new imaging biomarkers are proposed to improve diagnosis. Testing clinical-radiological biomarkers for positive diagnosis of HA in lobar hematomas is also suggested.
JOURNAL OF NEUROLOGY
(2023)
Article
Clinical Neurology
Ghil Schwarz, Gargi Banerjee, Isabel C. Hostettler, Gareth Ambler, David J. Seiffge, Hatice Ozkan, Simone Browning, Robert Simister, Duncan Wilson, Hannah Cohen, Tarek Yousry, Rustam Al-Shahi Salman, Gregory Y. H. Lip, Martin M. Brown, Keith W. Muir, Henry Houlden, Rolf Jager, David J. Werring
Summary: This study found associations between putative biomarkers of parenchymal CAA and putative biomarkers of leptomeningeal CAA, and suggested that CT biomarkers may help in diagnosing CAA, but MRI still plays an important role in ICH survivors with suspected CAA.
INTERNATIONAL JOURNAL OF STROKE
(2023)
Article
Psychology, Clinical
Emily M. Briceno, Miguel Arce Renteria, Alden L. Gross, Richard N. Jones, Christopher Gonzalez, Rebeca Wong, David R. Weir, Kenneth M. Langa, Jennifer J. Manly
Summary: This study presents a cultural neuropsychological approach to prestatistical harmonization of cognitive data across the United States and Mexico. By comparing linguistic and cultural equivalence, the researchers identified confident and tentative linking items. Results showed that a significant proportion of the linking items exhibited measurement differences across cohorts. The study highlights the importance of multidisciplinary and multilingual teams in identifying differences in cognitive construct measurement that may not be detected by statistical procedures alone.
Letter
Clinical Neurology
Nicolas Raposo, David J. Werring, Anand Viswanathan
ANNALS OF NEUROLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Stephanie L. Harrison, Benjamin J. R. Buckley, Deirdre A. Lane, Elnara Fazio-Eynullayeva, Paula Underhill, Andrew Hill, David J. Werring, Gregory Y. H. Lip
Summary: This study aimed to determine the impact of oral anticoagulants (OACs) plus antiplatelet agents (APA) on outcomes for patients with atrial fibrillation (AF) and carotid artery disease after ischemic stroke. The results suggest that receiving OACs without APA is associated with a lower risk of major bleeding and no negative impact on recurrent stroke or mortality in patients with AF and carotid artery disease. Evidence from randomized trials is needed to confirm this finding.
CARDIOVASCULAR DRUGS AND THERAPY
(2023)
Letter
Clinical Neurology
Philip S. Nash, F. Humphries, L. Benjamin, D. J. Werring
JOURNAL OF NEUROLOGY
(2023)
Letter
Clinical Neurology
Yang Du, Wenpeng Zhang, Martina Locatelli, Robert J. Simister, H. Rolf Jaeger, David J. Werring
JOURNAL OF NEUROLOGY
(2023)
Article
Clinical Neurology
Melinda B. Roaldsen, Agnethe Eltoft, Tom Wilsgaard, Hanne Christensen, Stefan T. Engelter, Bent Indredavik, Dalius Jatuzis, Guntis Karelis, Janika Korv, Erik Lundstrom, Jesper Petersson, Jukka Putaala, Mary-Helen Soyland, Arnstein Tveiten, Andrew Bivard, Stein Harald Johnsen, Michael Mazya, David J. Werring, Teddy Y. Wu, Gian Marco De Marchis, Thompson G. Robinson, Ellisiv B. Mathiesen
Summary: This study aimed to determine whether intravenous thrombolysis with tenecteplase within 4-5 hours of awakening could improve functional outcome in patients with ischaemic wake-up stroke selected with non-contrast CT. The results showed that treatment with tenecteplase was not associated with better functional outcome at 90 days, and the bleeding complications were similar between the treatment groups.
Article
Clinical Neurology
Alin Borha, Florent Lebrun, Emmanuel Touze, Evelyne Emery, Denis Vivien, Thomas Gaberel
Summary: Endovascular thrombectomy has changed the management of ischemic stroke. Decompressive craniectomy for ischemic stroke after thrombectomy could lead to a higher risk of hemorrhagic transformation, as shown in a mouse model of stroke induced by occlusion of the middle cerebral artery.
Article
Clinical Neurology
G. Schwarz, B. Kanber, F. Prados, S. Browning, R. Simister, H. R. Jager, G. Ambler, C. A. M. Gandini Wheeler-Kingshott, D. J. Werring
Summary: This study found that small vessel disease is the most common cause of spontaneous intracerebral hemorrhage and is associated with widespread microstructural brain tissue disruption, which can be quantified using diffusion tensor imaging metrics. The study found that whole-brain microstructural alterations are associated with functional outcome after intracerebral hemorrhage and have better predictive ability than existing hemorrhage scores.
JOURNAL OF NEUROLOGY
(2023)
Correction
Clinical Neurology
Yang Du, Wenpeng Zhang, Martina Locatelli, Robert J. Simister, H. Rolf Jager, David J. Werring
JOURNAL OF NEUROLOGY
(2023)
Article
Neurosciences
Edgar Chan, Ana-Marija Gal, Natasja Van Harskamp, Matthew E. Adams, Martin M. Brown, David J. Werring, Lisa Cipolotti, Robert Simister
Summary: Moyamoya Disease (MMD) is a rare cerebrovascular disorder that commonly affects the executive functions in adult patients. This study found that cognitive impairment was common in MMD patients, with executive functions being the most frequently affected. Long-term follow-up showed that the neuropsychological profile of MMD patients remained relatively stable, with no significant improvement or decline. Age of onset, history of stroke, or revascularization surgery did not affect the pattern of cognitive impairment.
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
(2023)
Article
Clinical Neurology
Ernst Mayerhofer, Livia Parodi, Savvina Prapiadou, Rainer Malik, Jonathan Rosand, Marios K. Georgakis, Christopher D. Anderson
Summary: Integrating a genetic risk score into a clinical risk score can improve risk stratification for anticoagulation-related intracerebral hemorrhage. A prediction score incorporating genomic information is superior to a clinical risk score alone for risk stratification in anticoagulant users.
Article
Clinical Neurology
Simon Fandler-Hoefler, Thomas Gattringer, Christian Enzinger, David J. Werring
Summary: This study found that patients with probable CAA who were diagnosed using the Boston v2.0 criteria had a lower risk of ICH recurrence compared to those diagnosed using the v1.5 criteria.
Letter
Medicine, General & Internal
David J. Werring, Gargi Banerjee
Review
Clinical Neurology
Kitti Thiankhaw, Hatice Ozkan, Gareth Ambler, David J. Werring
Summary: In patients with ischaemic stroke, there is a strong association between IADE and CSVD markers, such as lacunes, cerebral microbleeds, and white matter hyperintensities.
JOURNAL OF NEUROLOGY
(2023)