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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(12): s00451812887
DOI: 10.1055/s-0045-1812887
Neurology Practice

Cerebrospinal fluid biomarkers in cerebral amyloid angiopathy: insights from a clinical case series

Authors

  • Ana Silvia Sobreira Lima Verde 

    1   Hospital Geral de Fortaleza, Departamento de Neurologia, Fortaleza CE, Brazil.

  • Alessandra Braga Cruz Guedes de Morais 

    1   Hospital Geral de Fortaleza, Departamento de Neurologia, Fortaleza CE, Brazil.
    2   Universidade Federal de São Paulo, São Paulo SP, Brazil.

  • Amanda Vale Catunda 

    1   Hospital Geral de Fortaleza, Departamento de Neurologia, Fortaleza CE, Brazil.

  • João Igor Dantas Landim 

    1   Hospital Geral de Fortaleza, Departamento de Neurologia, Fortaleza CE, Brazil.

  • Ian Silva Ribeiro 

    1   Hospital Geral de Fortaleza, Departamento de Neurologia, Fortaleza CE, Brazil.

  • Bruno Diógenes Iepsen 

    1   Hospital Geral de Fortaleza, Departamento de Neurologia, Fortaleza CE, Brazil.

  • Norberto Anízio Ferreira Frota 

    1   Hospital Geral de Fortaleza, Departamento de Neurologia, Fortaleza CE, Brazil.
    3   Universidade de Fortaleza, Fortaleza CE, Brazil
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Abstract

Cerebral amyloid angiopathy (CAA) is a small vessel disease characterized by the deposition of amyloid-beta in small cerebral vessels, which can lead to intracerebral hemorrhages and cognitive impairment. Rare variants, such as cerebral amyloid angiopathy-related inflammation (CAA-ri) and iatrogenic CAA (ICAA), may mimic other neurological conditions and challenge diagnosis in clinical practice. We present three cases that illustrate distinct CAA syndromes, along with CSF biomarker analysis. One patient experienced recurrent hemorrhagic strokes with a history of dural graft, raising concerns about amyloid transmission. Two patients presented with rapidly progressive dementia that fulfilled CAA-ri criteria. All cases exhibited decreased levels of CSF Aβ40 and Aβ42, with one showing elevated p-tau, suggesting comorbid Alzheimer's pathology. Cerebrospinal fluid biomarkers complement neuroimaging in the diagnosis of CAA, aiding in differentiation from other dementias. Early recognition and diagnosis of CAA-ri variants is crucial, because immunotherapy may improve outcomes. Further research is necessary to establish biomarker thresholds and their clinical applicability.

Keywords

Cerebral Amyloid Angiopathy - Biomarkers - Amyloid Beta-Peptides - Cerebrospinal Fluid

Authors' Contributions

Conceptualization: ASSLV, NAFF; Data curation: ASSLV, ABCGM, AVC, JIDL, ISR; Formal analysis: ASSLV; Investigation: ASSLV; Methodology: NAFF; Project administration: NAFF; Supervision: NAFF; Validation: NAFF; Visualization: ASSLV; Writing – original draft: ASSLV; Writing – review & editing: BDI, NAFF.


Data Availability Statement

Data will be available upon request to the corresponding author.


Editor-in-Chief: Hélio A. G. Teive https://orcid.org/0000-0003-2305-1073.


Associate Editor: Caio César Disserol Diniz https://orcid.org/0000-0001-7568-0897.




Publication History

Received: 05 February 2025

Accepted: 04 September 2025

Article published online:
28 November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Ana Silvia Sobreira Lima Verde, Alessandra Braga Cruz Guedes de Morais, Amanda Vale Catunda, João Igor Dantas Landim, Ian Silva Ribeiro, Bruno Diógenes Iepsen, Norberto Anízio Ferreira Frota. Cerebrospinal fluid biomarkers in cerebral amyloid angiopathy: insights from a clinical case series. Arq Neuropsiquiatr 2025; 83: s00451812887.
DOI: 10.1055/s-0045-1812887