According to a study conducted by researchers from Weill Cornell Medicine, NewYork-Presbyterian, and Yale School of Medicine, a common type of brain hemorrhage in older adults, known as subdural bleeding, is associated with the presence of amyloid deposits in brain blood vessels. The study is the first to establish a link between amyloid in brain vessels and subdural bleeding and is expected to lead to a better understanding of both conditions.
For the study, which will be published on December 26 in JAMA Neurology, the researchers analyzed two large population-based cohorts with over 600,000 participants in the United Kingdom and the United States. They found that patients with amyloid deposits in brain vessels – a condition known as cerebral amyloid angiopathy (CAA) – were at least five times more likely to suffer from subdural bleeding compared to patients without CAA.
Currently, doctors generally do not consider isolated subdural bleeding as part of the spectrum of cerebral amyloid angiopathy. So, once this connection is established, doctors will start to investigate and evaluate underlying CAA in patients with subdural bleeding, which could mean a major paradigm shift leading to better care and improved outcomes.
Dr. Santosh Murthy, Co-Senior Author of the Study, Associate Professor of Neurology at Weill Cornell Medicine and Deputy Head of the Neurocritical Care Division at New York-Presbyterian/Weill Cornell Medical Center
The other co-senior author of the study was Dr. Guido Falcone, Associate Professor of Neurology at the Yale School of Medicine. The study’s first author was Dr. Cyprien Rivier, a postdoctoral fellow in the Falcone Lab.
Subdural bleeding is bleeding from blood vessels located on the outer surface of the brain beneath its largest covering membrane, the dura. It leads to blood accumulations, known as subdural hematomas, which can exert dangerous pressure on the brain and usually require surgical removal. Subdural bleeding affects almost 125,000 Americans annually and is on track to become the most common reason for brain surgeries in adult patients due to the aging population.
CAA exhibits amyloid-beta protein aggregates in the walls of blood vessels within and directly above the brain. The condition is very common in older adults, especially in Alzheimer’s patients who also have amyloid deposits in other brain tissues. Although CAA can cause bleeding from any of the vessels where it occurs, neurologists generally consider subdural bleeding as a separate clinical phenomenon mainly caused by mechanical stress on the vessels due to age-related brain shrinkage.