"Amyloid spells": Characterising the spectrum of transient focal neurological episodes in cerebral amyloid angiopathy

Dr Andreas Charidimou gave the talk entitled: "Clinical-radiological spectrum of transient focal neurological episodes in cerebral amyloid angiopathy: multicentre MRI cohort study and systematic review" [pdf].

Sporadic cerebral amyloid angiopathy (CAA) is a very common disease in the elderly which is caused by the progressive amyloid-β deposition in the walls of cortical small vessels in the brain. The most widely recognised clinical presentation of CAA is with symptomatic lobar intracerebral haemorrhage (ICH) in elderly individuals. CAA is also associated with transient focal neurologic episodes (TFNE) (sometimes called "amyloid spells"): these have been described as typically recurrent, stereotyped, spreading paraesthesias, usually lasting several minutes.

Our study is the first to systematically characterise the prevalence, clinical and imaging spectrum and prognostic significance of TFNE in CAA, in a European multicentre collaboration between the UK and Belgium. In summary, we have shown that: (1) TFNE are common in CAA; (2) TFNE have a spectrum of clinical features which include both predominantly positive ("aura-like") or negative ("TIA-like") symptoms; (3) TFNE may be caused by superficial cortical siderosis or convexity subarachnoid haemorrhage (cSAH); and (4) TFNE predict a high early risk of symptomatic ICH (about 50% at 2-3 months), which may be amenable to prevention.

Dr Andreas Charidimou: "I am delighted because the award is obviously a great honour and also an opportunity to increase awareness of cerebral amyloid angiopathy as a cause of neurological symptoms, including "amyloid spells".

Dr David Werring: "Cerebral amyloid angiopathy is a very common disease as populations get older, but is under-recognized by neurologists and stroke physicians. This work is important, because it clearly shows that transient focal neurological symptoms may be related to bleeding in the brain (rather than ischaemia), and signify a high risk of cerebral haemorrhage. This is a new observation with important treatment implications, because giving antiplatelet or anticoagulant drugs could be hazardous after these attacks if they are misdiagnosed. The study highlights the importance of blood-sensitive MRI sequences in investigating these types of episodes to make sure patients get the right treatment".

The team

Patrice Laloux	Yves Vandermeeren	Andre Peeters	Simone Gregoire
Zoe Fox	David J. Werring	Jean-Claude Baron	Rolf Jäger