case_images: PMC10985332_01
case_images: Timeline of important clinical events.
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case_images: PMC10985332_01_fneur-15-1360705-g001.jpg
case_images: fig1
case_images: A computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed bilateral frontal lobar ICH with significant mass effect (Figure 2; Supplementary Figure S1).
case_images: Serial CT brain scans in the first 6 months of presentation. Serial brain computed tomography (CT) findings of a patient with histopathologically confirmed, neurosurgery-associated iatrogenic cerebral amyloid angiopathy (CAA) showing recurrent lobar intracranial hemorrhage (red circles) in the first 6 months since admission. Taxifolin was commenced after around 8 weeks, as shown in the figure, with six new episodes of lobar ICH before taxifolin use and only three new episodes of lobar ICH after taxifolin use, with no newly detected lobar ICH since.
case_images: fneur-15-1360705-g002.jpg
case_images: PMC10985332_01_fneur-15-1360705-g002.jpg
case_images: fig2
case_images: A computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed bilateral frontal lobar ICH with significant mass effect (Figure 2; Supplementary Figure S1). Serial scans showed gradual resolution of the residual ICH, and the patient recovered full consciousness (Figure 2). In the first 6 to 10 months after taxifolin administration, a significant decrease in Abeta deposition was noted, as quantified by a 2-77% decrease in the SUVR across all the cortical regions of interest (Supplementary Table S1; Supplementary Figure S2).
case_images: Intraoperative and histopathological findings. (A) Intraoperative view of grossly swollen brain parenchyma with significant rebleeding in the left anterior temporal lobe; and (B,C) frontal subcortical intracerebral hemorrhage (white dotted line) during a left-sided decompressive craniectomy in which left anterior frontotemporal lobectomy was performed; (D-F) hematoxylin and eosin slides of the specimen demonstrate extensive replacement of the arteriolar smooth muscle layer with extracellular eosinophilic material; (G) Congo red staining shows salmon-pink appearing vessels; (H) with apple-green birefringence under polarized light; and (I) positive immunohistochemistry for involvement of Abeta.
case_images: fneur-15-1360705-g003.jpg
case_images: PMC10985332_01_fneur-15-1360705-g003.jpg
case_images: fig3
case_images: ICH was detected on CT, and a left decompressive craniectomy was performed. Intraoperatively, spontaneous rebleeding of the anterior temporal lobe and a frontal lobar ICH were observed that required further clot evacuation (Figures 3A-C). Histopathological examination of the resected brain tissue confirmed the diagnosis of CAA (Figures 3D-I).
case_images: Serial 11C-Pittsburgh compound B positive emission tomography (11C-PiB-PET) scans following taxifolin use. Serial 11C-PiB-PET scans in axial, sagittal, and coronal views followed in response to taxifolin use after 6 months (A), 10 months (B), and 15 months (C), respectively. Visually, amyloid deposition can be gaged according to the colored bar on the right, which corresponds to the cortical-to-cerebellar standardized uptake volume ratio (SUVR; red = high uptake, yellow-green = moderate uptake, blue = least uptake). Note that the semi-quantification parameter cortical-to-cerebellum SUVR is equal to "SUVmean/SUVmean in cerebellum," where SUVmean is the mean SUV within each cortical volume of interest.
case_images: fneur-15-1360705-g004.jpg
case_images: PMC10985332_01_fneur-15-1360705-g004.jpg
case_images: fig4
case_images: Three 11C-PiB-PET scans were performed at 5-month intervals starting after 6 months of taxifolin administration after the patient was stabilized (Figure 4).