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Age and Ageing Advance Access originally published online on September 18, 2006
Age and Ageing 2006 35(6):565-571; doi:10.1093/ageing/afl108
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© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Review

Sporadic cerebral amyloid angiopathy—an important cause of cerebral haemorrhage in older people

Bhomraj Thanvi and Tom Robinson

Leicester General Hospital, Medicine for the Care of Older People, Leicester, UK

Address correspondence to: B. Thanvi. Email: bthanvi{at}hotmail.com

Cerebral amyloid angiopathy (CAA) is an important cause of primary intracerebral haemorrhage (PICH) in older people, accounting for ~10% of all types of PICH. The amount of amyloid deposition in the vessels and vasculopathic changes determine the propensity to PICH. The risk factors of CAA include advanced age and the presence of certain alleles of apolipoprotein E. There are no specific clinical features of CAA-related PICH, although lobar, recurrent or multiple simultaneous haemorrhages in older patients should raise suspicion of its diagnosis. A definitive diagnosis of CAA requires pathological examination of the affected tissue. However, with modern imaging techniques, it is possible to make a diagnosis of ‘probable CAA’ in patients presenting with PICH. Gradient-echo magnetic resonance imaging is a sensitive, non-invasive technique for identifying small haemorrhages in life. Currently, there is no specific treatment available for CAA. Recent advances in the immunopathology and pathogenesis of CAA are expected to help in developing specific anti-amyloid therapy.

Keywords: cerebral amyloid angiopathy, primary intracerebral haemorrhage, older people, elderly


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