Senile cerebral amyloid angiopathy

Senile cerebral amyloid angiopathy

Definition:

Senile cerebral amyloid angiopathy is characterized by deposits of amyloid protein in the walls of the arteries of the brain, which increases the risk of bleeding into the brain (hemorrhagic stroke).

Alternative Names:

Amyloidosis - cerebral

Causes, incidence, and risk factors:

Senile cerebral amyloid angiopathy is a cause of lobar intracerebral hemorrhage (bleeding in a localized area of the brain, a form of stroke) in the elderly. There may be multiple episodes of bleeding, which may occur over a period of many months. The symptoms occur because bleeding in the brain harms brain tissue.

The cause is unknown. Amyloid protein is deposited in the arterial walls of the brain, and there are often no deposits elsewhere in the body. The major risk factor is age. The incidence is much greater in people older than 60.

Symptoms:

Headache (usually focal, localized to a specific part of the head)
Vomiting
Dementia (loss of cognitive ability)
Drowsiness
Neurologic changes (variable)
- May be sudden in onset
- Double vision, decreased vision
- Speech difficulties
- Confusion, delirium
- Weakness or paralysis
- Sensation changes or loss of sensation in an area
Seizures
Stupor or coma (rarely)

Signs and tests:

An examination shows focal neurologic deficits (brain function changes) that reflect the location of the bleeding. If there is a history of dementia, lobar hemorrhage may be suspected.

A CT scan or MRI of the head shows lobar intracerebral hemorrhage. Often, MRI or CT scan will show evidence of prior bleeding episodes that may or may not have been noticed. An angiography of the brain may be used to rule out arteriovenous malformation or aneurysm as the cause of the bleed.

Senile cerebral amyloid angiopathy is not specifically diagnosed until after death, when a postmortem biopsy reveals amyloid deposits in the blood vessels of the brain.

Treatment:

There is no known effective treatment. Treatment is supportive and based on the control of symptoms. In some cases, rehabilitiation is needed for weakness or clumsiness. This can include physical, occupational, or speech therapy.

Occasionally, some patients are good candidates for medications that can help improve memory.

Expectations (prognosis):

The disorder is generally progressive. It cannot be definitively diagnosed in most cases until after death.

Complications:

Lobar intracerebral hemorrhage, repeated episodes
Dementia
Seizures
Hydrocephalus ("water on the brain") (rarely)

Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if there is any sudden loss of movement, sensation, vision, speech or other impairments that may indicate a loss of neurologic functions.

Review Date: 7/31/2002
Reviewed By: Joseph V. Campellone, M.D., Division of Neurology, Cooper Hospital/University Medical Center, Camden, NJ. Review provided by VeriMed Healthcare Network.

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