Use of beta-blocker in cerebral proliferative angiopathy: A case report

•We describe a case of cerebral proliferative angiopathy in a patient with frequent episodes of disabling headaches.•The angiogram findings denoted a vast vascular tangle, which was interspersed with a functioning parenchyma.•A conservative management approach was adopted, which included regular clinical-radiological follow-up along with symptomatic medications.•Shrinkage of vascular lesion was noticed after seven years, and we attribute this shrinkage to the use of a beta-blocker. 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.