Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy.
BACKGROUND
Neuropathologic studies suggest an association between cerebral amyloid angiopathy (CAA) and small ischemic infarctions as well as hemorrhages. We examined the prevalence and associated risk factors for infarcts detected by diffusion-weighted imaging (DWI).


METHODS
We performed retrospective analysis of MR images from 78 subjects with a diagnosis of probable CAA and a similar aged group of 55 subjects with Alzheimer disease or mild cognitive impairment (AD/MCI) for comparison. DWI and apparent diffusion coefficient (ADC) maps were inspected for acute or subacute infarcts. We also examined the association between DWI lesions and demographic variables, conventional vascular risk factors, and radiographic markers of CAA severity such as number of hemorrhages on gradient-echo MRI and volume of T2-hyperintense white matter lesions.


RESULTS
Twelve of 78 subjects with CAA (15%) had a total of 17 DWI-hyperintense lesions consistent with subacute cerebral infarctions vs 0 of 55 subjects with AD/MCI (p = 0.001). The DWI lesions were located primarily in cortex and subcortical white matter. CAA subjects with DWI lesions had a higher median number of total hemorrhages (22 vs 4, p = 0.025) and no difference in white matter hyperintensity volume or conventional vascular risk factors compared to subjects with CAA without lesions.


CONCLUSIONS
MRI evidence of small subacute infarcts is present in a substantial proportion of living patients with advanced cerebral amyloid angiopathy (CAA). The presence of these lesions is associated with a higher burden of hemorrhages, but not with conventional vascular risk factors. This suggests that advanced CAA predisposes to ischemic infarction as well as intracerebral hemorrhage.
Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
W T
WT
Kimberly
A
A
Gilson
N S
NS
Rost
J
J
Rosand
A
A
Viswanathan
E E
EE
Smith
S M
SM
Greenberg
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000473:pathology; D001921:Brain / Q000473:pathology; D016657:Cerebral Amyloid Angiopathy / Q000150:complications* / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology; D002544:Cerebral Infarction / Q000209:etiology* / Q000473:pathology; D003072:Cognition Disorders / Q000150:complications / Q000473:pathology; D003430:Cross-Sectional Studies; D003625:Data Collection; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies