Diagnostic et prise en charge d'une angiopathie amyloïde cérébrale sporadique

We propose a synthesis of the literature on sporadic cerebral amyloid angiopathy (CAA). CAA is caused by vascular deposits of Aß-amyloid peptides leading to cerebral small vessel disease. Interest in CAA has been growing in the medical community due to population aging, the severity of its main complication i.e. spontaneous lobar hematoma, and the development of non-invasive diagnostic methods with susceptibility-weighted magnetic resonance imaging (MRI). CAA is associated with age and Alzheimer's disease (AD): cerebrovascular deposits of Aß peptides are present in nearly 60% of patients over 80 years of age and in over 80% of patients with AD. CAA is responsible for 12 to 15% of cerebral hematomas, with a characteristic lobar location and an annual recurrence risk of 10%. Susceptibility-weighted and gradient-echo MRI are used to make a diagnosis of probable CAA according to the Boston criteria that are based on the existence of lobar hemorrhage, lobar microbleeds, or superficial cortical siderosis. We discuss other clinical manifestations of CAA (amyloid spells and cognitive decline) as well as MRI manifestations (non-traumatic subarachnoid hemorrhage of the convexity, posterior predominant white matter hypersignals, micro-infarcts, and enlarged perivascular spaces of the centrum semi ovale). Prevention of lobar hematoma is mainly based on optimal control of blood pressure and cautious prescription of antithrombotic treatments. The inflammatory form of CAA is rare but curable condition.