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The Pathophysiology and Clinical Presentation of Cerebral Amyloid Angiopathy

  • Cardiovascular Disease and Stroke (M Fink and J Safdieh, Section Editors)
  • Published:
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Abstract

Cerebral amyloid angiopathy (CAA) is defined as the deposition of amyloid ß peptide within leptomeningial and cortical vessels, likely reflecting an imbalance between Aβ production and clearance. Amyloid buildup triggers a series of destructive alterations in the cerebral vascular architecture, leading to a spectrum of neurological events including lobar intracerebral hemorrhage, brain ischemia and cognitive decline. Although traditionally diagnosed pathologically, neuroimaging has taken a central role in defining CAA. This review will discuss the pathological, clinical and radiological aspects of CAA.

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Authors and Affiliations

  1. J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 175 Cambridge st, Suite 300, Boston, MA, 02114, USA

    Eitan Auriel & Steven Mark Greenberg

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  1. Eitan Auriel
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Correspondence to Steven Mark Greenberg.

Appendix

Appendix

Boston Criteria for Diagnosis of CAA-Related Hemorrhage [52]

  1. 1.

    Definite CAA

    Full postmortem examination demonstrating:

    Lobar, cortical, or corticosubcortical hemorrhage

    Severe CAA with vasculopathy

    Absence of other diagnostic lesion

  2. 2.

    Probable CAA with supporting pathology

    Clinical data and pathologic tissue (evacuated hematoma or cortical biopsy) demonstrating:

    Lobar, cortical, or corticosubcortical hemorrhage

    Some degree of CAA in specimen

    Absence of other diagnostic lesion

  3. 3.

    Probable CAA

    Clinical data and MRI or CT demonstrating:

    Multiple hemorrhages restricted to lobar, cortical, or corticosubcortical regions (cerebellar hemorrhage allowed)

    Age ≥55 years

    Absence of other cause of hemorrhage

  4. 4.

    Possible CAA

    Clinical data and MRI or CT demonstrating:

    Single lobar, cortical, or corticosubcortical hemorrhage

    Age ≥55 years

    Absence of other cause of hemorrhage

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Auriel, E., Greenberg, S.M. The Pathophysiology and Clinical Presentation of Cerebral Amyloid Angiopathy. Curr Atheroscler Rep 14, 343–350 (2012). https://doi.org/10.1007/s11883-012-0254-z

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