Use of beta-blocker in cerebral proliferative angiopathy: A case report
Describe a case of cerebral proliferative angiopathy in a patient with disabling headaches in which we noticed CPA lesion shrinkage with the use of a betablocker. Report the clinical details, radiographic and angiogram findings and medical management of a case based on the MOOSE Guidelines. The case...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Interdisciplinary Neurosurgery |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751922001773 |
| _version_ | 1811190401857486848 |
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| author | Glaucia Suzanna Jong-A-Liem Lillian dos Santos Carneiro Fernando Mendes Paschoal, Junior Feres Eduardo Aparecido Chaddad Neto Eberval Figueiredo Gadelha Edson Bor-Seng-Shu Eric Homero Albuquerque Paschoal |
| author_facet | Glaucia Suzanna Jong-A-Liem Lillian dos Santos Carneiro Fernando Mendes Paschoal, Junior Feres Eduardo Aparecido Chaddad Neto Eberval Figueiredo Gadelha Edson Bor-Seng-Shu Eric Homero Albuquerque Paschoal |
| author_sort | Glaucia Suzanna Jong-A-Liem |
| collection | DOAJ |
| description | Describe a case of cerebral proliferative angiopathy in a patient with disabling headaches in which we noticed CPA lesion shrinkage with the use of a betablocker. Report the clinical details, radiographic and angiogram findings and medical management of a case based on the MOOSE Guidelines. The case described in this paper is about a young man with CPA who, at first, complained of headache with migraine characteristics. Headaches became disabling. According to international protocols for the treatment of migraine, the prophylactic treatment of migraine with tricyclics and beta-blockers is recommended. During outpatient follow-up, the good therapeutic response to the medications was notorious, with a reduction in the frequency and intensity of migraine attacks. During the outpatient follow-up, a new control angiography was performed, seven years after the first, in which major changes in the vasculature with shrinkage of the lesion were found. This beta-blocker, more specifically propranolol, is widely studied and used in infantile haemangioma, in which it acts as a VEGF inhibitory agent. This, in turn, is a master regulator of angiogenesis. Experimental studies have shown that propranolol has a cytotoxic and antiproliferative effect on stem and endothelial cells, thus also affecting the perivascular cell contraction of infantile haemangioma – thus leading to lesion regression, and often avoiding surgical procedures. There are some studies that have also demonstrated the efficacy of propranolol on cerebral cavernomas of familial presentation that are difficult to access surgically. Could Propranolol have a similar antiproliferativa and cytotoxic influence in CPA? Propranolol may have an antiproliferative effect on CPA. Studies with a higher level of evidence will need to be carried out to take this as true and as a therapeutic or adjuvant method for cases of CPA. For the time being, we still recommend a conservative therapeutic approach. |
| first_indexed | 2024-04-11T14:50:48Z |
| format | Article |
| id | doaj.art-8d0cff22dbb14b85ad6fd20291aa49ec |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-04-11T14:50:48Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-8d0cff22dbb14b85ad6fd20291aa49ec2022-12-22T04:17:30ZengElsevierInterdisciplinary Neurosurgery2214-75192023-03-0131101663Use of beta-blocker in cerebral proliferative angiopathy: A case reportGlaucia Suzanna Jong-A-Liem0Lillian dos Santos Carneiro1Fernando Mendes Paschoal, Junior2Feres Eduardo Aparecido Chaddad Neto3Eberval Figueiredo Gadelha4Edson Bor-Seng-Shu5Eric Homero Albuquerque Paschoal6Neurosurgery Department, Hospital Ophir Loyola, 992, Magalhaes Barata, Avenue, Belém, PA 66063240, BrazilMedical School, University Center of the State of Pará, 3775, Almirante Barroso, Avenue, Belém, PA 66616903, BrazilNeurology Department, Hospital da Aeronáutica de Belém, 3492, Almirante Barroso, Avenue, Belém, PA 66613710, BrazilNeurosurgery Department, Hospital São Paulo, Universidade Federal de São Paulo, 715, Napoleão de Barros, Street, São Paulo, SP 04024002, BrazilNeurosurgery Department, Hospital das Clínicas de São Paulo, 255, Dr. Enéas Carvalho de Aguiar, Street, São Paulo, SP 05403000, BrazilNeurosurgery Department, Hospital das Clínicas de São Paulo, 255, Dr. Enéas Carvalho de Aguiar, Street, São Paulo, SP 05403000, BrazilNeurosurgery Department, Hospital Ophir Loyola, 992, Magalhaes Barata, Avenue, Belém, PA 66063240, Brazil; Neurosurgery Department, Hospital São Paulo, Universidade Federal de São Paulo, 715, Napoleão de Barros, Street, São Paulo, SP 04024002, Brazil; Neurosurgery Department, Hospital das Clínicas de São Paulo, 255, Dr. Enéas Carvalho de Aguiar, Street, São Paulo, SP 05403000, Brazil; Corresponding author at: Neurosurgery Department, Hospital Ophir Loyola, 992, Magalhaes Barata, Avenue, Belém, PA 66063240, Brazil.Describe a case of cerebral proliferative angiopathy in a patient with disabling headaches in which we noticed CPA lesion shrinkage with the use of a betablocker. Report the clinical details, radiographic and angiogram findings and medical management of a case based on the MOOSE Guidelines. The case described in this paper is about a young man with CPA who, at first, complained of headache with migraine characteristics. Headaches became disabling. According to international protocols for the treatment of migraine, the prophylactic treatment of migraine with tricyclics and beta-blockers is recommended. During outpatient follow-up, the good therapeutic response to the medications was notorious, with a reduction in the frequency and intensity of migraine attacks. During the outpatient follow-up, a new control angiography was performed, seven years after the first, in which major changes in the vasculature with shrinkage of the lesion were found. This beta-blocker, more specifically propranolol, is widely studied and used in infantile haemangioma, in which it acts as a VEGF inhibitory agent. This, in turn, is a master regulator of angiogenesis. Experimental studies have shown that propranolol has a cytotoxic and antiproliferative effect on stem and endothelial cells, thus also affecting the perivascular cell contraction of infantile haemangioma – thus leading to lesion regression, and often avoiding surgical procedures. There are some studies that have also demonstrated the efficacy of propranolol on cerebral cavernomas of familial presentation that are difficult to access surgically. Could Propranolol have a similar antiproliferativa and cytotoxic influence in CPA? Propranolol may have an antiproliferative effect on CPA. Studies with a higher level of evidence will need to be carried out to take this as true and as a therapeutic or adjuvant method for cases of CPA. For the time being, we still recommend a conservative therapeutic approach.http://www.sciencedirect.com/science/article/pii/S2214751922001773Cerebral proliferative angiopathyChronic ischemiaBetablockerHeadacheCase report |
| spellingShingle | Glaucia Suzanna Jong-A-Liem Lillian dos Santos Carneiro Fernando Mendes Paschoal, Junior Feres Eduardo Aparecido Chaddad Neto Eberval Figueiredo Gadelha Edson Bor-Seng-Shu Eric Homero Albuquerque Paschoal Use of beta-blocker in cerebral proliferative angiopathy: A case report Interdisciplinary Neurosurgery Cerebral proliferative angiopathy Chronic ischemia Betablocker Headache Case report |
| title | Use of beta-blocker in cerebral proliferative angiopathy: A case report |
| title_full | Use of beta-blocker in cerebral proliferative angiopathy: A case report |
| title_fullStr | Use of beta-blocker in cerebral proliferative angiopathy: A case report |
| title_full_unstemmed | Use of beta-blocker in cerebral proliferative angiopathy: A case report |
| title_short | Use of beta-blocker in cerebral proliferative angiopathy: A case report |
| title_sort | use of beta blocker in cerebral proliferative angiopathy a case report |
| topic | Cerebral proliferative angiopathy Chronic ischemia Betablocker Headache Case report |
| url | http://www.sciencedirect.com/science/article/pii/S2214751922001773 |
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