Amyloid spells and high blood pressure: Imminent danger?

• Autor(a) principal: Caetano, A.
• Data de Publicação: 2015
• Outros Autores: Pinto, M., Calado, S., Viana-Baptista, M.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.1159/000369922
• topic: Cerebral amyloid angiopathy; Cortical and leptomeningeal vessels; Elderly patients; bisoprolol; furosemide; aged; antihypertensive therapy; Article; blood pressure monitoring; blood pressure regulation; brain hemorrhage; case report; electroencephalogram; emergency ward; heart arrest; human; hypertension; low drug dose; male; nuclear magnetic resonance imaging; priority journal; Rankin scale; subarachnoid hemorrhage; tonic clonic seizure; vascular amyloidosis

We present the case of a 71-year-old male, admitted after a generalized tonic-clonic seizure, with a history of recurrent left arm and face paresthesias, associated with sulcal cortical subarachnoid hemorrhages. During the next 48 h, he remained agitated with a high blood pressure profile; he also suffered a cardiac arrest in relation to a severe left fronto-parietal and a smaller right parietal parenchymal hemorrhage that developed over the subarachnoid hemorrhage locations. There were no intracranial vascular abnormalities. Three months later, an MRI revealed disseminated superficial siderosis. He was discharged with a modified Rankin scale of 4. He died 1 month later of unknown cause. A diagnosis of probable cerebral amyloid angiopathy was assumed. Patients with pathologically proven cerebral amyloid angiopathy that present with transient focal neurological symptoms in relation to cortical bleeds, the so-called 'myloid spells' seem to be at an increased risk of future parenchymal hemorrhages. Avoiding antiplatelet agents in these cases has been proposed. Our case suggests that these patients should be monitored closely in the hyperacute phase, and tight blood pressure control should be considered as the immediate risk of bleeding may be high, even without a definitive diagnosis of cerebral amyloid angiopathy. © 2015 S. Karger AG, Basel.