eMedicine Specialties > Neurology > Neuro-vascular Diseases

Cerebral Amyloid Angiopathy: Follow-up

Author: Ravi S Menon, MD, Assistant Professor of Neurology, Georgetown University
Coauthor(s): Jose G Merino, MD, Medical Director, Suburban Hospital Stroke Program; Vladimir C Hachinski, MD, MSc, DSc, FRCP(C), Professor, Departments of Medicine, Physiology, London Health Sciences Center, University of Western Ontario, Canada
Contributor Information and Disclosures

Updated: Jan 4, 2010

Follow-up

Deterrence/Prevention

Patients with cerebral amyloid angiopathy (CAA) have an increased risk of bleeding while taking warfarin, even when the level of anticoagulation is in the therapeutic range (ie, international normalized ratio, 2-3). The vasculopathic changes may predispose these patients to small bleeds. The use of anticoagulants may result in the enlargement of small hemorrhages that otherwise would have remained asymptomatic. Withdrawal of anticoagulant agents is a prudent intervention to prevent recurrences in patients with prior lobar hemorrhages, particularly if GRE MRI suggests earlier petechial hemorrhages. Antiplatelet agents are a safer alternative.

Strong evidence regarding the relationship between CAA and antithrombotic therapy is lacking. Recent data suggest that GRE microbleeds are more prevalent among a cohort of aspirin users in the Rotterdam Scan Study; however, more research is needed to understand the dynamic between antithrombotic therapy and the risk of intracerebral hemorrhage and microbleed formation.12 In the patient with coronary artery disease, cardiac stents, and/or ischemic stroke, the benefit of antithrombotic therapy is clear and withdrawal of antiplatelet therapy requires prudent consideration of multiple factors. Management must be tailored to each individual case, taking into account the risk of hemorrhage, the benefit of stroke prophylaxis, and the preferences of the patient.

Prognosis

Recurrence of CAA-related ICH is common. In one series studying lobar hemorrhage, the recurrence rate was reported to be 38% and the mortality rate high at 44%. Of the recurrences, 36% occurred in the same location. A history of hemorrhagic stroke before the index lobar hemorrhage can predict early recurrence of ICH.

 


More on Cerebral Amyloid Angiopathy

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Differential Diagnoses & Workup: Cerebral Amyloid Angiopathy
Treatment & Medication: Cerebral Amyloid Angiopathy
Follow-up: Cerebral Amyloid Angiopathy
Multimedia: Cerebral Amyloid Angiopathy
References
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Further Reading

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Keywords

cerebrovascular amyloidosis, cerebral amyloid angiopathy, congophilic angiopathy, dysphoric angiopathy, β-amyloid, beta-amyloid, Alzheimer's disease, intracranial hemorrhage, ICH, dementia, transient neurologic events, hereditary cerebral hemorrhage with amyloidosis, hereditary cerebral hemorrhage with amyloidosis-Dutch type, hereditary cerebral hemorrhage with amyloidosis-Icelandic type, HCHWA, cerebral microbleeds, stroke, ischemic strokes

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Contributor Information and Disclosures

Author

Ravi S Menon, MD, Assistant Professor of Neurology, Georgetown University
Ravi S Menon, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Society of Neuroimaging, and American Stroke Association
Disclosure: Nothing to disclose.

Coauthor(s)

Jose G Merino, MD, Medical Director, Suburban Hospital Stroke Program
Jose G Merino, MD is a member of the following medical societies: American Heart Association and American Stroke Association
Disclosure: Nothing to disclose.

Vladimir C Hachinski, MD, MSc, DSc, FRCP(C), Professor, Departments of Medicine, Physiology, London Health Sciences Center, University of Western Ontario, Canada
Vladimir C Hachinski, MD, MSc, DSc, FRCP(C) is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Neurological Association, and Ontario Medical Association
Disclosure: Mitsubi Tanaba Pharma Corporation Honoraria Speaking and teaching; Ferrer Group Honoraria Speaking and teaching

Medical Editor

Thomas A Kent, MD, Professor, Department of Neurology, Baylor College of Medicine; Neurology Care Line Executive, Michael E DeBakey Veterans Affairs Medical Center
Thomas A Kent, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, New York Academy of Sciences, Royal Society of Medicine, Sigma Xi, and Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health & Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Concentric Medical Consulting fee Review panel membership; Abbott Consulting fee Consulting; Sanofi  Consulting

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