CEREBRAL AMYLOID ANGIOPATHY- NOT SO AVOIDABLE - NOT SO DISMAL A NEW HOPE Honourable Editor Sir, I read an intresting article by Cheridimou A and collegues published in February 2012 issue of our estttmed journal1. The authors have very nicely reviewed the sporadic cerebral amyloid angiopathy (CAA) in a very excellent and precise way. The efforts made by authors are worth appriciation by the readres. Here I would like to share my views as under- 1- Age and hypertension are the two most important risk factors for stroke of either ischaemic or haemorrhagic type. Age probably is a strong risk factor because of cerebral amylod angiopathy. Hypertension almost always can worsen the stroke or cognitive impairment but age may not depending upon presence or abscence of cerebral amyloid angiopathy. 2- Further insight into the link between neurons and vascular system named as "neurovascular link" will also help understand the cerebral amyloid angiopathy better2. 3- Role of anti-inflammatory or disease modifying agents may have a promising role which requires prospective double blinded large scale trials. Further more the same may be studied in the patients taking anti-inflammatory or disease modifying drugs for some other purposes. The factor of bias may be calculated by means of stanndard satatistical mathods. 4- Bloob pressure may be kept on lower side in susceptible population. 5-Patients of stoke with microbleeds be managed carefully so as to avoid haemorrhagic comlications3. If Magnetic resonance imaging facility is not available or not affordable, the topography of the ischaemic lesions and leukoaraiosis along with other stroke risk factors may help guide regarding the possibility of cerebral amyloid angiopathy and the precautions accordingly for judicious use of antithrombotic therapy or thrombolysis. This is implicable for resource poor third world countries. REFFRENCES- 1- Andreas Charidimou, Qiang Gang, David J Werring. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum. J Neurol Neurosurg Psychiatry.2012;83:124-137. 2-Quaegebeur A, Lange C, Carmellet P. The neurovascular link in health and disease: molecular mechanism and therapeutic implication. Neuron. August 2011,Vol 11, issue 3-406-422. 3-Van Es C A G M et al. Cerebral microbleeds and cognitive functioning,the "PROPOSAL" study. Neurology October 11, 2011,Vol 77,No.15; 1446-1452.

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