Cerebral convexity subarachnoid hemorrhage: various causes and role of diagnostic imaging

Mangla, Rajiv; Drumsta, Douglas; Alamst, Jeevak; Mangla, Manisha; Potchen, Michael J.

doi:10.1007/s10140-014-1251-z

Cited by 16 publications

(5 citation statements)

References 39 publications

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“…The repeat CT showed improvement in punctate hyperdensities, which made the diagnosis of cSAH less likely. Subacute ICoVT (5–14 days) is difficult to differentiate from cSAH because of the similar radiographic appearance when parenchymal involvement is absent ( 29 ). Subacute ICoVT and cSAH are usually observed along the sulci and are shown as hyperdensities on NCCT and hyperintensities on FLAIR images.…”

Section: Discussionmentioning

confidence: 99%

Malignant Isolated Cortical Vein Thrombosis as the Initial Manifestation of Primary Antiphospholipid Syndrome: Lessons on Diagnosis and Management From a Case Report

et al. 2022

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BackgroundAntiphospholipid syndrome (APS) with isolated cortical vein thrombosis (ICoVT) is an extremely rare but potentially malignant entity. It is particularly challenging to diagnose APS-related ICoVT because of the non-specific clinical manifestations and the frequent absence of typical neuroimaging. Moreover, there is currently limited knowledge on the clinical features and management strategies for the condition. Delays in diagnosis and treatment may lead to life-threatening consequences.Case PresentationWe present a rare case of a 74-year-old Chinese woman who presented with sudden onset of headache and right arm weakness that mimicked acute ischemic stroke. Her initial computed tomography was unremarkable, and intravenous thrombolysis was performed. Serial neuroimages confirmed ICoVT 4 days after symptom onset, and low-molecular-weight heparin (LMWH) was started at a dose of 0.4 ml twice per day, according to the 2019 Chinese guidelines. The workup for the predisposing causes of ICoVT revealed triple positivity APS. LMWH dose was adjusted according to the anti-Xa chromogenic assay. However, the patient’s condition deteriorated rapidly, and there was a progressive enlargement of the venous infarction despite treatment with anticoagulants. Transtentorial herniation developed on day 12, and decompressive craniectomy was immediately performed. The patient’s symptoms did not improve significantly after surgery, and she remained aphasic and hemiplegic at the 3-month follow-up, with a modified Rankin Scale score of 5.ConclusionICoVT is a rare yet potentially fatal manifestation of APS, and its diagnosis and treatment are extremely challenging. Timely diagnosis, prompt treatment, and close monitoring are essential to improve the clinical prognosis of patients with APS-related ICoVT.

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Section: Discussionmentioning

confidence: 99%

Malignant Isolated Cortical Vein Thrombosis as the Initial Manifestation of Primary Antiphospholipid Syndrome: Lessons on Diagnosis and Management From a Case Report

et al. 2022

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“…In RCVS, vasoconstriction of the intracranial vessels and subsequent vasodilatation is thought to cause rupture of friable cortical pial vessels leading to cSAH [ 9 - 10 ]; this process affects the distal vessels typically in a diffuse pattern. In fact, cSAH is part of the RCVS2 score, a clinical algorithm designed to differentiate RCVS from other causes of vasculopathy [ 11 ] and hemorrhagic complications are known to occur in ⅓ of patients with RCVS [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Multifocal Atraumatic Convexity Subarachnoid Hemorrhage

Dakay¹,

Azher²,

Mahta³

et al. 2021

Cureus

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Background Multifocal convexity subarachnoid hemorrhage (cSAH) has generally been described in the setting of traumatic brain injury, however, it has also been reported in the absence of trauma in conditions such as with reversible cerebral vasoconstriction syndrome. We describe the clinical and radiographic characteristics of multifocal cSAH in an academic center. Methods We analyzed our single-center retrospective database of nontraumatic convexity subarachnoid hemorrhage from January 2015-January 2018. Convexity subarachnoid hemorrhage was defined as blood in one or more cortical sulci in the absence of trauma; patients with blood in the cisterns or Sylvian fissure were excluded. Multifocal location was defined as at least two distinct foci of hemorrhage occurring in two or more lobes. Clinical and neuroimaging data were collected. Results Out of 70 total patients with convexity subarachnoid hemorrhage, 13 cases were of multifocal convexity subarachnoid hemorrhage, occurring in 18.6% of all cases. The mean age was 58 years (SD = 14.7). Eleven patients were female. Seven patients had reversible cerebral vasoconstriction syndrome (RCVS)/posterior reversible encephalopathy syndrome (PRES), two had cerebral amyloid angiopathy (CAA), three had intrinsic coagulopathy, and one patient had endocarditis as the etiology of multifocal cSAH. Headache was the most common complaint, in eight (61.5%) patients. Conclusion Multifocal cSAH occurs in approximately 18.6% of all cSAH and can occur in the absence of trauma. In our larger cohort of all cSAH, CAA was the most common cause; however, multifocal cSAH is more commonly caused by RCVS/PRES spectrum. Clinicians should be aware that multifocal cSAH can occur in the absence of trauma, and may be a harbinger of RCVS/PRES, particularly in young patients with thunderclap headaches.

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“…Atraumatic convexal subarachnoid hemorrhage (c-SAH) is an unusual presentation of subarachnoid bleeding, typically sparing basal cisterns, ventricles, parenchyma, and interhemispheric fissures [1]. The most common etiologies are cerebral amyloid angiopathy (CAA), reversible cerebral vasoconstriction syndrome (RCVS), and dissection of intracranial arteries, but many other rare causes have been reported [1][2][3][4]. In the clinical practice, the etiology remains undetermined in a consistent percentage of cases (~20%) [3].…”

Section: Introductionmentioning

confidence: 99%

Convexal subarachnoid hemorrhage and acute ischemic stroke: a border zone matter?

et al. 2019

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Background Convexal subarachnoid hemorrhage (c-SAH) is an infrequent condition with variable causes. c-SAH concomitant to acute ischemic stroke (AIS) is even less frequent, and the relationship between the two conditions remains unclear. Methods Between January 2016 and January 2018, we treated four patients who were referred to our stroke unit with ischemic stroke and concomitant nontraumatic c-SAH. The patients underwent an extensive diagnostic workup, including digital subtraction angiography (DSA). Results All four patients developed acute focal neurological symptoms with restricted MRI diffusion in congruent areas. In three of the patients, infarcts were in a border zone between the main cerebral arteries and c-SAH was nearby. The fourth patient showed a small cortical infarct, and c-SAH was in a border zone territory of the contralateral hemisphere. An embolic source was discovered or strongly suspected in all cases. One patient was treated with intravenous thrombolysis, but this treatment was not related to c-SAH. None of the four patients showed microbleeds or further cortical siderosis, thus excluding cerebral amyloid angiopathy. In addition, DSA did not show signs of vasculitis, reversible cerebral vasoconstriction syndrome, or intracranial arterial dissection. Conclusions We proposed the embolism or hemodynamic changes of the border zone arterioles as a unifying pathogenetic hypothesis of coexisting c-SAH and AIS.

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Cerebral convexity subarachnoid hemorrhage: various causes and role of diagnostic imaging

Cited by 16 publications

References 39 publications

Malignant Isolated Cortical Vein Thrombosis as the Initial Manifestation of Primary Antiphospholipid Syndrome: Lessons on Diagnosis and Management From a Case Report

Malignant Isolated Cortical Vein Thrombosis as the Initial Manifestation of Primary Antiphospholipid Syndrome: Lessons on Diagnosis and Management From a Case Report

Multifocal Atraumatic Convexity Subarachnoid Hemorrhage

Convexal subarachnoid hemorrhage and acute ischemic stroke: a border zone matter?

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