2025 American Academy of Neurology Abstract Website

Warda Alrubasy¹, Shams Sameer¹, Mohammad Jehad Taha¹, Mohammad Abuawwad¹, Husam Abu Daoud², Hamidullah Sahibzada¹, Hend Abo Helow³, ‪Ekram Hasanin‬‏⁴, Mostafa Mahrous⁵, Muhammad Sabrah⁶
¹Cairo University, Faculty of Medicine, ²Palestine Polytechnic University, Faculty of Medicine, ³Al Azhar University, Faculty of Medicine, ⁴Faculty of medicine, University of Tripoli, ⁵Augusta University, Faculty of Medicine, ⁶Cairo University, Faculty of medicine

Objective:

This systematic review and meta-analysis aim to synthesize evidence from case reports on the iatrogenic transmission of amyloid proteins linked to CAA and AD.

Background:

Cerebral amyloid angiopathy (CAA) and Alzheimer’s disease (AD) are neurodegenerative disorders characterized by the abnormal deposition of amyloid proteins. Recent findings have raised concerns about the potential for iatrogenic transmission of these misfolded proteins through surgical and medical procedures.

Design/Methods:

A systematic search was performed across 5 databases to identify relevant case reports and case series. Data on patient demographics, medical history, interventions, and results were extracted and qualitatively analyzed. The quality of the included studies was evaluated using the NIH quality assessment tool. The protocol was submitted to PROSPERO (CRD42024570305).

Results:

Our search yielded 29 cases from all over the world. Patients were almost equally distributed into male or female (16 males and 13 females). The mean age at the time of intervention was 11.69±14.58 years, and the average age on presentation was 47.31±14.687 years, leaving an average latency period of 34.93±7.92 years. Most patients’ brains were contaminated by cadaveric dura mater graft (n=20, 68.97%), less frequently contaminated surgical instruments (n=8,27.59%) and RBC transfusion (n=2,6.9%). Diagnosis was made based on neuroimaging techniques in (n=10, 34.48%) patients, brain biopsy (n=9, 31.03%) or both (n=10, 34.48%). Amyloid-beta (Aβ) plaques ware observed in most patients (n=25, 86.2%). Tau tangles, neuritic plaques, prion like deposited were only found in 3 patients (10.34%), each. Lewy bodies were only reported in one case (3.45%).

Conclusions:

This systematic review highlights the possibility for iatrogenic transmission of amyloid-beta (Aβ) plaques, particularly in patients who underwent neurosurgery and cadaveric dura mater grafts. Significant latency periods between intervention and clinical manifestation were noted. These findings emphasize the need for increased awareness and further research to prevent amyloid transmission through medical procedures.