CEREBRAL AMYLOID ANGIOPATHY IN PREGNANCY: A CASE REPORT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cerebral Amyloid Angiopathy (CAA) is amyloid deposition within cerebral vessel walls which increases risk for spontaneous intracerebral hemorrhage (ICH) and occurs almost exclusively in patients over age 65. We report a young woman patient who presented ICH with both imaging tissue pathology consistent CAA. CASE PRESENTATION: A 36-year-old G1P0 at 34 weeks gestation to the hospital after one day of severe headache. She denied recent trauma. Upon arrival fetus was distress prompting emergent delivered via cesarean section. The subsequently underwent CT head revealing an acute 6.3cm x 5.4cm 3.1cm right parieto-occipital parenchymal significant vasgoenic edema. Also noted, concomitant subdural component hemorrhage, extending extra-axially up 1 cm diameter same region. There resulting right-to-left midline shift, body lateral ventricle nearly completely effaced. intubated due developing encephalopathy neurosurgery completed urgent craniotomy. initially improved extubated three days later; however, four procedure she developed recurrent pertinent further shift ventricular narrowing new uncal deviation. middle meningeal artery embolization interventional radiology remove source bleed. recovered following without complications transferred out ICU. During initial craniotomy, sample sent evaluation noted congophilic DISCUSSION: While CAA can be presumed or MRI imaging, it optimally confirmed Congo Red stain under polarized light microscopy. Epidemiologically, strongly correlates thus rarely considered women childbearing age. are few reports diagnosis pregnant population, likely misdiagnosis given other common pathologies such as gestational hypertension preeclampsia predispose ICH. Additionally, invasive nature confirming this may play role procedures pregnancy. Mortality 10-30% depending on location size bleeding. Risk bleeding much higher than causes no currently agreed upon management However, there some evidence use steroids immunosuppressants decrease related vasogenic It also reasonable suggest prevention hemorrhagic events avoidance blood thinners. CONCLUSIONS: should present regardless Confirmation biopsy preferred proper treatment. REFERENCE #1: Vinters, H. angiopathy. critical review. Stroke. 1987; 8(2):311-324. #2: Rosand, J. Muzikansky, A. Kumar, Wisco, JJ. Smith, EE. Betensky, RA. Greenberg, SM. Spatial clustering hemorrhages probable Ann Neurol. 2005;58(3):459. #3: S. Vonsattel Diagnosis Sensitivity specificity cortical biopsy. 1997;28(7):1418. DISCLOSURES: No relevant relationships by PARNEET DHALIWAL, source=Web Response Jessica Kent, Adan (Adam) Mora, Ciara Wisecup,