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senile cerebral amyloid angiopathy

Alternative Names
cerebral amyloid angiopathy, congophilic cerebral angiopathy, cerebrovascular amyloidosis

Senile cerebral amyloid angiopathy is a condition in which a protein is deposited into the walls of the blood vessels that supply blood to the brain. The protein that gets deposited is called amyloid.

What is going on in the body?
It is not known why amyloid gets deposited into the brain's blood vessel walls in senile cerebral amyloid angiopathy. The protein deposits weaken the blood vessels. This results in a greatly increased risk for bleeding into the brain, known as intracerebral haemorrhage. The bleeding may cause permanent brain damage or death.

What are the signs and symptoms of the condition?
Symptoms only exist if there is an intracerebral haemorrhage. This bleeding into the brain usually causes sudden symptoms, including: What are the causes and risks of the condition?
The exact cause of senile cerebral amyloid angiopathy is not known. Most cases occur in people older than 60 years.

What can be done to prevent the condition?
There are no known ways to prevent senile cerebral amyloid angiopathy.

How is the condition diagnosed?
A doctor may suspect senile cerebral amyloid angiopathy after the history and physical examination. Imaging studies of the brain, such as a cranial CT scan or cranial MRI, will show the bleeding into the brain. However, there are other causes of bleeding into the brain, such as high blood pressure. Examining a piece of the person's brain with a microscope is the only way to diagnose this condition. This is usually only done after death, during an autopsy.

What are the long-term effects of the condition?
A person with senile cerebral amyloid angiopathy usually has repeated episodes of bleeding into the brain over a period of months or years. Each episode of bleeding carries a risk of death or permanent brain damage. After each episode of bleeding, a person usually becomes more and more disabled. The person may become totally dependent on others for his or her basic needs. Death will eventually occur.

What are the risks to others?
Senile cerebral amyloid angiopathy is not known to be contagious or inherited.

What are the treatments for the condition?
There are no known treatments for senile amyloid angiopathy. However, treatment is needed when an intracerebral haemorrhage occurs. Treatment often involves the use of medications such as mannitol to reduce the pressure within the brain. An individual with large bleeding episodes may benefit from craniotomy, which is brain surgery, to remove the blood in or around the brain. Medications are also used to treat seizures if they occur.

Other treatment depends on the type of brain damage or disability the person develops. For example, a person may need a device to help him or her walk, such as a cane or walker. Others may need around-the-clock nursing care to help them eat, bathe, and dress.

What are the side effects of the treatments?
All medications have possible side effects. For example, mannitol can cause allergic reactions and salt imbalances. Surgery carries a risk of further bleeding, brain damage, infection, and allergic reaction to anaesthesia.

What happens after treatment for the condition?
Treatment depends on the person's medical problems and disabilities after the bleeding episode. Because senile cerebral amyloid angiopathy cannot be diagnosed for certain before death and no treatment is available, further treatment is based on the person's current needs. People usually get gradually worse with each episode of bleeding.

How is the condition monitored?
The person should seek immediate attention if any of the symptoms of bleeding into the brain occur. Other monitoring is based on the person's needs and disabilities.

Author: James Broomfield, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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