Expert medical negligence lawyer responds to news of neurological condition iCAA linked to dura mater grafts

A Sky News investigation has highlighted a devastating neurological condition called iatrogenic cerebral amyloid angiopathy (iCAA). Concern has been expressed that the use of cadaver-derived dura mater grafts in neurosurgical procedures has caused iCAA. 

With only 52 confirmed cases globally it's a rare condition, and further investigation will be needed to establish the scope of the problem.

What is iCAA?

iCAA is a form of cerebral amyloid angiopathy. The iatrogenic form is caused by medical intervention, making it different from the other forms, which can be inherited or arise spontaneously.

iCAA is a neurodegenerative disease characterised by the accumulation of amyloid-beta protein in the blood vessels of the brain. This build-up causes the vessels to become fragile, leading to brain haemorrhages, seizures, memory loss, and confusion. In many cases, it also increases susceptibility to Alzheimer’s disease and stroke. It can be fatal and unfortunately there's currently no cure.

The Sky News investigation identified the use of dura mater grafts as a likely cause of iCAA. These grafts were used by surgeons to ‘patch’ defects in the dura mater, as well as in other types of procedure such as spinal surgery. The grafts were made from tissue collected from deceased donors (cadavers) and were widely used in the 1970s up to the late 1980s.

The link to cadaver grafts

Sky News reports that scientists now believe minute fragments of amyloid-beta protein may have been transferred during these procedures. These fragments can lie dormant for decades before triggering disease which is a process known as “seeding”. The latency period means many patients are only now being diagnosed, decades after their original surgeries. 

Looking ahead and potential legal claims

Victims and their families may want to seek redress but could face significant hurdles with legal claims. 

It's likely there will be challenging issues of law, both in terms of proving a link between dura mater grafts and iCAA and establishing who is responsible. 

It will be necessary to establish fault (negligence) and that any injuries suffered were avoidable. Medical records or other key evidence might no longer be available, given that the relevant operations took place so long ago. 

On the other hand, it's possible to see parallels with the cadaveric human growth hormone programme, which was belatedly ended in 1985 because patients were being exposed to the risk of another neurodegenerative disease called iatrogenic Creutzfeldt-Jakob Disease. 

In the subsequent CJD Litigation, the Court determined that the hGH treatment programme should have ended by 1 July, 1977, because of the known risk of iCJD. Irwin Mitchell is the law firm that brought the CJD litigation and has since supported many victims and their families with claims for compensation.

This means we understand the terrible impact of diseases like iCJD or iCAA. We recognise that behind every diagnosis is a person and their family, whose lives have been irrevocably changed. While the use of cadaveric dura mater grafts has long since ceased, the legacy of these procedures is only now coming into full view. 

Conclusion

The medical community is working to better understand iCAA, and I look forward to seeing advice from the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO). 

I hope that the government will carry out a thorough investigation which provides answers to victims and their families and that, where appropriate, compensation can be obtained for those affected.

Find out more about Irwin Mitchell's expertise in supporting people and families affected by patients receiving infected transplants at our dedicated product liability claims section. 

More information about Sky News' investigation can be found on its website.