Acute Convexity Subarachnoid Hemorrhage Related to Cerebral Amyloid Angiopathy: Clinicoradiological Features and Outcome

Calvière, Lionel; Cuvinciuc, Victor; Raposo, Nicolas; Faury, A.; Cognard, Christophe; Larrue, Vincent; Viguier, Alain; Bonneville, Fabrice

doi:10.1016/j.jstrokecerebrovasdis.2015.11.010

Cited by 43 publications

(28 citation statements)

References 33 publications

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“…The most distinctive neuroimaging feature between the two groups was the much higher prevalence of disseminated and multifocal cSS in patients with CAA with acute cSAH. In line with a recent study,15 the reported prevalence of cSS in this group is much higher compared with histopathology-confirmed CAA-ICH9 and the reported prevalence in a previous imaging study of CAA-ICH 23. The high prevalence of cSS among patients with CAA-related acute cSAH and the high prevalence of TFNE in patients with CAA with either cSAH or cSS suggest a link between cSAH and cSS 8 41.…”

Section: Discussionsupporting

confidence: 83%

Acute convexity subarachnoid haemorrhage and cortical superficial siderosis in probable cerebral amyloid angiopathy without lobar haemorrhage

Charidimou

Boulouis

Fotiadis

et al. 2017

J Neurol Neurosurg Psychiatry

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Section: Discussionsupporting

confidence: 83%

Acute convexity subarachnoid haemorrhage and cortical superficial siderosis in probable cerebral amyloid angiopathy without lobar haemorrhage

Charidimou

Boulouis

Fotiadis

et al. 2017

J Neurol Neurosurg Psychiatry

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“…On CT, cSAH may appear as a subtle curvilinear hyperdensity localised to one or more adjacent sulci. 89 Hence, it is thought that detection of cSS by the radiologist can be utilised as proof of not only symptomatic cSAH, but also prior silent cSAH. 87,88 Sub-acutely and chronically, susceptibility-sensitive MRI sequences can be used to detect the low-signal hemosiderin residues that are left after cSAH resolution, known as cortical superficial siderosis (cSS) (Fig.…”

Section: Radiotherapymentioning

confidence: 99%

“…87 However, T2 FLAIR MRI sequences are more sensitive, where the haemorrhage will acutely appear as high signal. 89 Although CAA is likely the most common cause of cSS and cSAH in those aged 65 years or more, there are other aetiologies to consider (Table 4). 3).…”

Section: Radiotherapymentioning

confidence: 99%

Cerebral amyloid angiopathy: Review of clinico‐radiological features and mimics

et al. 2018

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Cerebral amyloid angiopathy (CAA) is an important cause of lobar intracerebral haemorrhage (ICH) in the elderly, but has other clinico-radiological manifestations. In the last two decades, certain magnetic resonance imaging (MRI) sequences, namely gradient-recalled echo imaging and the newer and more sensitive susceptibility-weighted imaging, have been utilised to detect susceptibility-sensitive lesions such as cerebral microbleeds and cortical superficial siderosis. These can be utilised sensitively and specifically by the Modified Boston Criteria to make a diagnosis of CAA without the need for 'gold-standard' histopathology from biopsy. However, recently, other promising MRI biomarkers of CAA have been described which may further increase precision of radiological diagnosis, namely chronic white matter ischaemia, cerebral microinfarcts and lobar lacunes, cortical atrophy, and increased dilated perivascular spaces in the centrum semiovale. However, the radiological manifestations of CAA, as well as their clinical correlates, may have other aetiologies and mimics. It is important for the radiologist to be aware of these clinico-radiological features and mimics to accurately diagnose CAA. This is increasingly important in a patient demographic that has a high prevalence for use of antiplatelet and antithrombotic medications for other comorbidities which inherently carries an increased risk of ICH in patients with CAA.

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“…Patients first presenting with TFNEs also had a higher total SVD summary score (mean 6 SD; 3.5 6 1.3 vs 2.9 6 1.2; p , 0.001) and this remained significant in an ordinal logistic regression, adjusting for age vascular risk factors (adjusted OR [2][3][4] in patients with cognitive symptoms and 3 [3][4] in those with TFNEs, both p , 0.001). 28 This was almost entirely driven by a higher number of CMBs (1 in ICH patients vs 5 [3][4][5][6][7][8][9][10][11][12][13] in patients with cognitive symptoms and 7 in those with TFNEs, p 5 0.001 and p , 0.001; see tables e-1 and e-2 and figure e-1 at Neurology.org for details). DISCUSSION We demonstrated that patients with probable CAA without symptomatic ICH first presenting with TFNEs bore a higher burden of quantifiable SVD-related damage compared to patients with probable CAA first evaluated for cognitive symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…11 It has been shown that patients with CAA first seen for acute neurologic symptoms often develop recurrent symptoms and are at high risk of developing subsequent ICH, [12][13][14] while an association with higher risk of bleeding has not been described in memory clinic patients, who demonstrate cognitive decline over time.…”

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confidence: 99%

Small vessel disease burden in cerebral amyloid angiopathy without symptomatic hemorrhage

et al. 2017

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Objective: Cerebral amyloid angiopathy (CAA) is a common age-related small vessel disease (SVD). Patients without intracerebral hemorrhage (ICH) typically present with transient focal neurologic episodes (TFNEs) or cognitive symptoms. We sought to determine if SVD lesion burden differed between patients with CAA first presenting with TFNEs vs cognitive symptoms.Methods: A total of 647 patients presenting either to a stroke department (n 5 205) or an outpatient memory clinic (n 5 442) were screened for eligibility. Patients meeting modified Boston criteria for probable CAA were included and markers of SVD were quantified, including cerebral microbleeds (CMBs), perivascular spaces, cortical superficial siderosis (cSS), and white matter hyperintensities (WMHs). Patients were classified according to presentation symptoms (TFNEs vs cognitive). Total CAA-SVD burden was assessed using a validated summary score. Individual neuroimaging markers and total SVD burden were compared between groups using univariable and multivariable models.Results: There were 261 patients with probable CAA included. After adjustment for confounders, patients first seen for TFNEs (n 5 97) demonstrated a higher prevalence of cSS (p , 0.0001), higher WMH volumes (p 5 0.03), and a trend toward higher CMB counts (p 5 0.09). The total SVD summary score was higher in patients seen for TFNEs (adjusted odds ratio per additional score point 1.46, 95% confidence interval 1.16-1.84, p 5 0.013). Conclusions:Patients with probable CAA without ICH first evaluated for TFNEs bear a higher burden of structural MRI SVD-related damage compared to those first seen for cognitive symptoms. This study sheds light on neuroimaging profile differences across clinical phenotypes of patients with CAA without ICH. Neurology ® 2017;88:878-884 GLOSSARY BG 5 basal ganglia; CAA 5 cerebral amyloid angiopathy; CI 5 confidence interval; CMB 5 cerebral microbleed; CSO 5 centrum semiovale; cSS 5 cortical superficial siderosis; FLAIR 5 fluid-attenuated inversion recovery; ICH 5 intracerebral hemorrhage; IQR 5 interquartile range; OR 5 odds ratio; PVS 5 perivascular spaces; SVD 5 small vessel disease; TE 5 echo time; TFNE 5 transient focal neurologic episode; WMH 5 white matter hyperintensity.Sporadic cerebral amyloid angiopathy (CAA) is characterized by progressive deposition of b-amyloid in the walls of cortical and leptomeningeal small arteries, resulting in vessel dysfunction and brain parenchymal injury. CAA is common in older individuals and, when severe, can lead to devastating consequences including intracerebral hemorrhage (ICH) and dementia. 1,2While definite diagnosis relies on pathology, clinical and neuroimaging criteria (the Boston criteria) can reliably identify CAA in older patients with lobar hemorrhage.3,4 More recently, an updated version of these criteria has demonstrated that the presence of $2 lobar cerebral microbleeds (CMBs) in patients without large hemorrhage is specific for moderate to severe CAA pathology presence in older individuals seen in a h...

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Acute Convexity Subarachnoid Hemorrhage Related to Cerebral Amyloid Angiopathy: Clinicoradiological Features and Outcome

Cited by 43 publications

References 33 publications

Acute convexity subarachnoid haemorrhage and cortical superficial siderosis in probable cerebral amyloid angiopathy without lobar haemorrhage

Acute convexity subarachnoid haemorrhage and cortical superficial siderosis in probable cerebral amyloid angiopathy without lobar haemorrhage

Cerebral amyloid angiopathy: Review of clinico‐radiological features and mimics

Small vessel disease burden in cerebral amyloid angiopathy without symptomatic hemorrhage

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