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Reduction of microbleeds by immunosuppression in a patient with Aβ-related vascular inflammation.

Traschütz A, Tzaridis T, Penner AH, Kuchelmeister K, Urbach H, Hattingen E, Heneka MT - Neurol Neuroimmunol Neuroinflamm (2015)

Bottom Line: Under long-term immunosuppressive treatment, a reduced number of cortical micobleeds was observed on repeat MRIs because of both the prevention of new microbleeds and the clearance of those existing at baseline.This study provides Class IV evidence.This is a single observational study without controls.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany; Department of Neuroradiology (H.U.), University of Freiburg, Germany; and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany.

ABSTRACT

Objective: To investigate whether the occurrence or clearance of microhemorrhages in cerebral amyloid angiopathy (CAA)-related vascular inflammation can be modified by immunosuppressive treatment.

Methods: Clinical and radiologic follow-up for more than 5 years of a patient with histopathologically confirmed CAA-related vascular inflammation treated with a prolonged and tapered regimen of IV cyclophosphamide and oral steroids.

Results: Under long-term immunosuppressive treatment, a reduced number of cortical micobleeds was observed on repeat MRIs because of both the prevention of new microbleeds and the clearance of those existing at baseline.

Conclusions: Sustained immunosuppression should be considered and systematically investigated as a treatment option for cortical microbleeds in CAA and related inflammatory phenotypes.

Classification of evidence: This study provides Class IV evidence. This is a single observational study without controls.

No MeSH data available.


Related in: MedlinePlus

Imaging of disease onset and treatment responseRepeat MRI scans including fluid-attenuated inversion recovery (FLAIR) (A) and T2 fast field echo (B) sequences. All images were acquired on a 3T MRI scanner. Upon initiation of immunosuppressive treatment in April 2009, there was a rapid resolution of FLAIR hyperintensities within 8 weeks. In response to the following maintenance therapy, the number of microbleeds markedly dropped.
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Figure 1: Imaging of disease onset and treatment responseRepeat MRI scans including fluid-attenuated inversion recovery (FLAIR) (A) and T2 fast field echo (B) sequences. All images were acquired on a 3T MRI scanner. Upon initiation of immunosuppressive treatment in April 2009, there was a rapid resolution of FLAIR hyperintensities within 8 weeks. In response to the following maintenance therapy, the number of microbleeds markedly dropped.

Mentions: Consistent with left temporal intermittent epileptiform activity in the first EEG, the initial CT scan revealed a subcortical hypodensity with contrast enhancement in the left parieto-occipital-temporal lobe. A cranial MRI showed diffuse cerebral edema in the right frontobasal and temporal region, as well as in the left temporopolar compartment with multiple parenchymal hemorrhages (figure 1). Diffusion-weighted and contrast-enhanced images, including a venous angiogram, were normal. Cerebral venous sinus thrombosis and dural arteriovenous fistulae were excluded by catheter angiography. An otolaryngeal examination was unremarkable, and a CT scan revealed fluid retention in the left mastoid without affecting the bone. Blood tests including a screening for thrombophilia were normal except for low thyroid-stimulating hormone and a mild elevation of C-reactive protein. CSF analysis including ferritin showed an elevated protein of 559 mg/L (range <500) but was otherwise normal. Antiepileptic treatment was initiated with carbamazepine and the patient was discharged.


Reduction of microbleeds by immunosuppression in a patient with Aβ-related vascular inflammation.

Traschütz A, Tzaridis T, Penner AH, Kuchelmeister K, Urbach H, Hattingen E, Heneka MT - Neurol Neuroimmunol Neuroinflamm (2015)

Imaging of disease onset and treatment responseRepeat MRI scans including fluid-attenuated inversion recovery (FLAIR) (A) and T2 fast field echo (B) sequences. All images were acquired on a 3T MRI scanner. Upon initiation of immunosuppressive treatment in April 2009, there was a rapid resolution of FLAIR hyperintensities within 8 weeks. In response to the following maintenance therapy, the number of microbleeds markedly dropped.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608757&req=5

Figure 1: Imaging of disease onset and treatment responseRepeat MRI scans including fluid-attenuated inversion recovery (FLAIR) (A) and T2 fast field echo (B) sequences. All images were acquired on a 3T MRI scanner. Upon initiation of immunosuppressive treatment in April 2009, there was a rapid resolution of FLAIR hyperintensities within 8 weeks. In response to the following maintenance therapy, the number of microbleeds markedly dropped.
Mentions: Consistent with left temporal intermittent epileptiform activity in the first EEG, the initial CT scan revealed a subcortical hypodensity with contrast enhancement in the left parieto-occipital-temporal lobe. A cranial MRI showed diffuse cerebral edema in the right frontobasal and temporal region, as well as in the left temporopolar compartment with multiple parenchymal hemorrhages (figure 1). Diffusion-weighted and contrast-enhanced images, including a venous angiogram, were normal. Cerebral venous sinus thrombosis and dural arteriovenous fistulae were excluded by catheter angiography. An otolaryngeal examination was unremarkable, and a CT scan revealed fluid retention in the left mastoid without affecting the bone. Blood tests including a screening for thrombophilia were normal except for low thyroid-stimulating hormone and a mild elevation of C-reactive protein. CSF analysis including ferritin showed an elevated protein of 559 mg/L (range <500) but was otherwise normal. Antiepileptic treatment was initiated with carbamazepine and the patient was discharged.

Bottom Line: Under long-term immunosuppressive treatment, a reduced number of cortical micobleeds was observed on repeat MRIs because of both the prevention of new microbleeds and the clearance of those existing at baseline.This study provides Class IV evidence.This is a single observational study without controls.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology (A.T., T.T., M.T.H.), Neuroradiology (A.-H.P., E.H.), and Neuropathology (K.K.), University of Bonn, Germany; Department of Neuroradiology (H.U.), University of Freiburg, Germany; and German Center for Neurodegenerative Disease (M.T.H.), Bonn, Germany.

ABSTRACT

Objective: To investigate whether the occurrence or clearance of microhemorrhages in cerebral amyloid angiopathy (CAA)-related vascular inflammation can be modified by immunosuppressive treatment.

Methods: Clinical and radiologic follow-up for more than 5 years of a patient with histopathologically confirmed CAA-related vascular inflammation treated with a prolonged and tapered regimen of IV cyclophosphamide and oral steroids.

Results: Under long-term immunosuppressive treatment, a reduced number of cortical micobleeds was observed on repeat MRIs because of both the prevention of new microbleeds and the clearance of those existing at baseline.

Conclusions: Sustained immunosuppression should be considered and systematically investigated as a treatment option for cortical microbleeds in CAA and related inflammatory phenotypes.

Classification of evidence: This study provides Class IV evidence. This is a single observational study without controls.

No MeSH data available.


Related in: MedlinePlus