Contents:
- Medical Video: Stanford Amyloid Center: Kevin Anderson's story
- Why does amyloid angiopathy cause bleeding in the brain?
- Who can get amyloid angiopathy?
- How to diagnose amyloid angiopathy?
- What are the symptoms of amyloid angiopathy?
- What is the treatment of amyloid angiopathy?
Medical Video: Stanford Amyloid Center: Kevin Anderson's story
Although the deposition of amyloid proteins in the brain was originally described in 1907, it took decades for scientists to realize that this slow progressive condition could be a cause of bleeding in the brain or the so-called intracerebral hemorrhage (ICH). In the early 20th century, it was found that deposition of amyloid was found in the brains of people with dementia towards the end of their lives, giving rise to the hypothesis that amyloid deposition was associated with dementia. Starting in the 1960s, several published reports also showed deposition of amyloid in the brains of the elderly who died from intracerebral hemorrhage (ICH). The more this report is published, the more clear that amyloid deposition is closely related both to dementia and some forms of ICH. Over time, this condition is known as amyloid angiopathy.
Why does amyloid angiopathy cause bleeding in the brain?
Amyloid deposits tend to accumulate inside the walls of arteries in the brain, causing them to deteriorate over time until they break and bleed. Very often, bleeding is localized to a small area called "petechial bleeding," but when amyloid angiopathy leads to large bleeding, it can be life threatening.
One sign of ICH caused by amyloid angiopathy, is that it occurs usually in the area near the surface of the brain, in a distribution that is generally referred to as "lobar".
Who can get amyloid angiopathy?
Factors that trigger the risk of amyloid angiopathy are unknown. A clear risk factor so far seems to be age, because amyloid deposition is common in people over 55 years of age. The relationship between some forms of the apolipoprotein E gene and amyloid angiopathy has also been reported, but at the end of 2008, this was still speculative.
How to diagnose amyloid angiopathy?
The trusted method used to diagnose amyloid angiopathy is a brain biopsy. Because a biopsy is a surgical procedure that has a certain risk of bleeding and / or infection, a biopsy will not be done unless absolutely necessary. Fortunately, doctors can now make an initial diagnosis of amyloid angiopathy using the MRI form, called "the gradient echo"(GRE), a very efficient test for bleeding in the brain regardless of small or large bleeding and whether it lasts for several hours or years. The hallmark of amyloid angiopathy seen in GRE is often referred to as "cortical micro-brain bleeding".
What are the symptoms of amyloid angiopathy?
Symptoms of amyloid angiopathy vary depending on how much bleeding is caused by damage to blood vessels. When bleeding is small, there may be no symptoms at all. In some cases, symptoms can not be seen clearly, causing progressive memory loss or a mild decrease in brain function, such as blurred vision. When bleeding is large, there are major neurological symptoms including, hemiparesis, hemiplegia, loss of consciousness, convulsions, coma and even death.
What is the treatment of amyloid angiopathy?
When bleeding occurs in the brain, treatment of ICH caused by amyloid angiopathy is no different from the treatment of ICH caused by other factors. First, if bleeding causes an increase in intracerebral pressure (ICP), from swelling or mass effects, the doctor may need to do emergency surgery or apply other measures to relieve ICP. Doctors also treat patients with anti-seizure drugs to prevent seizures. If the bleeding is small but significant enough to cause a stroke, the doctor will monitor the patient for one day or more in intensive care until the patient's condition is stable.
At present, little can be done to eliminate the deposition of amyloid proteins. Those diagnosed with this disorder should keep blood pressure normal and avoid blood thinners, such as aspirin or plavix, because both can increase the risk of bleeding in the brain.
