Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector39610.17816/psaic396Clinical analysisКлинический разборUnknownCerebral amyloid angiopathy (case report)Церебральная амилоидная ангиопатияhttps://orcid.org/0000-0001-9929-2725DobryninaLarisa A.ДобрынинаЛариса Анатольевна
Russian Federation

D. Sci. (Med.), Head, 3rd Neurology department

д.м.н., г.н.с., рук. 3-го неврологического отделения

dobrla@mail.ruKalashnikovaLyudmila A.КалашниковаЛюдмила Андреевна
Russian Federation
dobrla@mail.ruhttps://orcid.org/0000-0001-5539-245XKonovalovRodion N.КоноваловРодион Николаевич
Russian Federation

Cand. Sci. (Med.), senior researcher, Neuroradiology department

к.м.н., с.н.с. отд. лучевой диагностики

dobrla@mail.ruhttps://orcid.org/0000-0001-7491-7215KadykovAlbert S.КадыковАльберт Серафимович
Russian Federation

D. Sci. (Med.), Professor, senior researcher, 3rd Neurological department

д.м.н., проф., г.н.с. 3-го неврологического отделения

dobrla@mail.ruResearch Center of NeurologyФГБНУ «Научный центр неврологии»1409200823384307022017Copyright ©; 2008, Dobrynina L.A., Kalashnikova L.A., Konovalov R.N., Kadykov A.S.Copyright ©; 2008, Dobrynina L.A., Kalashnikova L.A., Konovalov R.N., Kadykov A.S.2008Dobrynina L.A., Kalashnikova L.A., Konovalov R.N., Kadykov A.S.Dobrynina L.A., Kalashnikova L.A., Konovalov R.N., Kadykov A.S.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/396

Cerebral amyloid angiopathy (CAA) is characterized by β-amyloid deposition in cortical and leptomeningeal arteries of small and medium size that disturbs normal structure of arterial wall. CAA is one of the often causes of peripheral intracerebral hemorrhages and cognitive impairment in old patients. We describe male patient, 52 years with CAA. Clinical picture was characterized by recurrent cortical-subcortical (lobar) hemorrhages, cognitive impairment of subcortiical type and epileptic seizures. MRI revealed superficial posthemorrhagic lesions. Gradient-echo MRI found small multiple asymptomatic hemorrhages in cerebral cortex and subcortical matter. Repeat gradientecho MRI carried out monthes revealed new clinically asymptomatic hemorrhages. Arterial hypertension as a cause of intracerebral hemorrhage was excluded on the base of atypical location of hemorrhage (superficial, but not deep). CAA diagnosis was made according to international Boston criteria: multiple lobar, cortical-subcortical hemorrhages not connected with other definite cause of intracerebral hemorrhage. Gradient-echo MRI is of a great importance in diagnosis of CAA, as it discovers small cortical and superficial hemorrhages, none detected by standard MRI regimes.

Церебральная амилоидная ангиопатия (ЦАА) характеризуется отложением бета-амилоида в корковых и лептоменингеальных артериях среднего и небольшого калибра, который нарушает нормальную структуру сосудистой стенки. ЦАА является одной из достаточно частых причин поверхностно расположенных внутримозговых кровоизлияний и когнитивных нарушений у пациентов старших возрастных групп. Описан больной 52 лет с ЦАА. Клиническая картина заболевания была представлена повторными корково-субкортикальными (лобарными) кровоизлияниями, когнитивными нарушениями (КН) субкортикального типа и эпилептическими припадками (ЭП). МРТ в режимах Т2 и Т1 обнаружила поверхностно расположенные очаговые изменения, соответствовавшие перенесенным кровоизлияниям. МРТ в режиме градиентное эхо (Т2*) обнаружила множественные небольшие, асимптомно развившиеся кровоизлияния в коре и подлежащем белом веществе. Повторная МРТ головного мозга (Т2*-режим) через 3 месяца обнаружила появление новых клинически асимптомных кровоизлияний. Артериальная гипертония как причина кровоизлияний была исключена на основе нетипичной для нее локализации очагов (поверхностная, а не глубинная). Диагноз ЦАА был поставлен на основе международных Бостонских критериев, включающих наличие множественных лобарных, корковых и корково-подкорковых кровоизлияний, не связанных с приемом антикоагулянтов, мальформациями, васкулитом и т.д. Большое значение в диагностике имеет МРТ в режиме градиентное эхо (Т2*), позволяющая выявить клинически асимптомные кровоизлияния.

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