Amyloid-β (Aβ) is a peptide deposited in the brain parenchyma in Alzheimer’s disease and in the wall of small cortical and leptomeningeal vessels in cerebral amyloid angiopathy (CAA). Sporadic CAA is prevalent in an ageing population and is a major cause of intracerebral haemorrhage and dementia. There is evidence of Aβ transmission through medical procedures, such as injection of cadaver-derived growth hormone (GH) or cadaveric dura mater graft in humans, in the context of iatrogenic Creutzfeldt-Jakob disease (iCJD).1 Interestingly, there is increasing evidence to suggest that Aβ transmission may also occur in the absence of iCJD through neurosurgical procedures.2 3 This paper describes a case of early onset, pathologically proven CAA presenting with multiple symptomatic intracerebral haemorrhages occurring three decades after cardiac surgery involving a cadaveric dura mater patch. A young male with multiple intracerebral haemorrhages underwent an extensive multimodal evaluation including clinical examination, cerebral MRI, amyloid positron emission tomography using 18F-florbetapir, apolipoprotein E (APOE) genotype, genetic testing for mutations or duplication causing hereditary CAA (amyloid precursor protein (APP), gelsolin, transthyretin and cystatin 3) and neuropathological examination of a brain biopsy. Sporadic CAA was confirmed pathologically. Childhood exposure to cadaveric dura mater was suspected based on the surgical history for congenital heart disease, then confirmed. The patient’s informed consent was obtained. A man aged 34 years presented with multiple symptomatic lobar intracerebral haemorrhages. He had a medical history of transposition of the great arteries, requiring neonatal cardiac surgery with the Rashkind procedure. At 2 years of age, the patient underwent repeat surgery with a Senning …

中文翻译：

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使用尸体硬脑膜片通过心脏手术进行的淀粉样β传播。

淀粉样蛋白-β（Aβ）是一种沉积在阿尔茨海默氏病脑实质中以及在脑淀粉样血管病（CAA）中的小皮质和轻薄脑膜血管壁中沉积的肽。零星的CAA普遍存在于人口老龄化中，是导致脑出血和痴呆的主要原因。在医源性克雅氏病（iCJD）的背景下，有证据表明Aβ通过医学程序传播，例如在人体中注射尸体衍生的生长激素（GH）或尸体硬脑膜移植物。1有趣的是，越来越多的证据提示在没有iCJD的情况下，通过神经外科手术也可能发生Aβ传播。23本文描述了一个早期发作的病例，经病理证实的CAA，在涉及尸体硬脑膜修补的心脏手术后三十年出现多发性症状性脑出血。一名患有多发性脑出血的年轻男性经历了广泛的多模式评估，包括临床检查，脑部MRI，使用18F-florbetapir的淀粉样蛋白正电子发射断层扫描，载脂蛋白E（APOE）基因型，基因突变检测或重复导致遗传性CAA（淀粉样蛋白前体蛋白（APP） ），凝溶胶蛋白，运甲状腺素蛋白和半胱氨酸蛋白酶抑制剂3）和脑活检的神经病理学检查。散发性CAA在病理上得到确认。根据先天性心脏病的手术史，怀疑儿童尸体硬脑膜暴露，然后证实。获得患者的知情同意。一名34岁的男子出现多发性症状性大叶脑出血。他有大动脉移位的病史，需要使用Rashkind手术进行新生儿心脏手术。在2岁时，患者接受了Senning…