Iatrogenic cerebral amyloid angiopathy: Two cases linked to childhood cadaveric dural transplantation for different intracranial pathologies, diagnosed using the simplified Edinburgh computed tomography criteria.

Abstract

Background: Cerebral amyloid angiopathy (CAA) is an age-related condition marked by amyloid-β (Aβ) accumulation in the small cerebral vessels. Iatrogenic cerebral amyloid angiopathy (iCAA) is a distinct form of CAA in younger patients with a history of cranial surgeries involving cadaveric dural transplants. Both iCAA and CAA are linked to recurrent lobar intracerebral hemorrhage (ICH). This article highlights iCAA as a distinct variant, discussing the possibility of using simplified Edinburgh computed tomography (CT) criteria as a possible diagnostic tool for CAA and carefully considering plausible childhood surgery, with the risk of Aβ transmission through dural grafts in all, especially middle-aged patients.

Case description: We present two cases of iCAA in a 46-year-old female and a 52-year-old male who suffered recurrent spontaneous lobar ICHs. The CAA was diagnosed using the simplified Edinburgh CT criteria, leading to further investigations into the underlying pathology. Based on their age, iCAA was suspected, and only after a meticulous search of the hospital documentation it was discovered that they both underwent cranial surgeries in childhood involving cadaveric dural grafts. The diagnosis of iCAA was established using the proposed diagnostic criteria by Banerjee et al. and later confirmed by pathological examination.

Conclusion: Our paper emphasizes the simplified Edinburgh criteria as a potential yet preliminary diagnostic tool for iCAA, while also highlighting the long-term risks of iatrogenic amyloid transmission related to dural grafting following various neurosurgical procedures.