Cerebral Microbleeds and Cortical Superficial Siderosis in Patients Presenting With Minor Cerebrovascular Events

Zerna, Charlotte; Modi, Jayesh; Bilston, Lisa; Shoamanesh, Ashkan; Coutts, Shelagh B.; Smith, Eric E.

doi:10.1161/strokeaha.116.013418

Cited by 23 publications

(13 citation statements)

References 27 publications

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“…Similarly, neuroimaging may enhance the prognostic ability following TIA and minor stroke. However, recent analyses of patients with TIA or minor IS show that white matter lesions are associated with disability at 90 days, but not with stroke progression or stroke recurrence [6], and micro bleeds predict neither 90-day outcome or recurrence [7].…”

Section: Introductionmentioning

confidence: 99%

Corneal nerve and endothelial cell damage in patients with transient ischemic attack and minor ischemic stroke

et al. 2019

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ObjectiveTo determine if corneal confocal microscopy can identify corneal nerve and endothelial cell abnormalities and may be useful in the prognostication of patients with transient ischemic attack [1] or minor ischemic stroke (IS).MethodsThirty-six patients admitted with TIA (n = 14) or minor IS (n = 22) underwent transcranial Doppler evaluation and corneal confocal microscopy and were compared with 18 healthy controls.ResultsCorneal nerve fiber density (P = 0.002), branch density (P = 0.004) and fiber length (P = 0.004) were significantly lower in patients with TIA or minor IS compared to controls, with no difference between patients with TIA and minor IS. Endothelial cell density (P = 0.003) was lower and endothelial cell area (P = 0.003) and perimeter (P = 0.006) were significantly higher in patients with TIA or minor IS compared to controls, with no difference between patients with TIA and minor IS. There were no differences in corneal nerve or endothelial cell morphology between patients with and without abnormal cerebrovascular reactivity. HbA1c was independently associated with CNFL, and endothelial cell polymegathism and pleomorphism were associated with both HbA1c and total cholesterol.ConclusionCorneal confocal microscopy identifies corneal nerve fiber loss and endothelial cell abnormalities in patients with TIA and minor IS and independent associations with HbA1c and cholesterol.

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Section: Introductionmentioning

confidence: 99%

Corneal nerve and endothelial cell damage in patients with transient ischemic attack and minor ischemic stroke

et al. 2019

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“…There are fewer data on the proportion of possible TIA that may instead be CAA-related TFNEs. In one prospective study of patients with possible ischemic symptoms who were consecutively consented to undergo MRI, 4/416 (1.0%) were retrospectively assessed as having CAA-related TFNEs 50 . Thus, current evidence suggests that most non-traumatic cSAH in the elderly, three quarters of cSS, and 1% of suspected TIA cases may be related to CAA.…”

Section: Incidence Of Caa-related Tfnesmentioning

confidence: 99%

Cerebral Amyloid Angiopathy–Related Transient Focal Neurologic Episodes

et al. 2021

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Transient focal neurological episodes (TFNEs) are brief disturbances in motor, somatosensory, visual or language functions that can occur in patients with cerebral amyloid angiopathy (CAA) and may be difficult to distinguish from transient ischemic attacks (TIAs) or other transient neurological syndromes. They herald a high rate of future lobar intracerebral hemorrhage, making it imperative to differentiate them from TIAs to avoid potentially dangerous use of antithrombotic drugs. Cortical spreading depression or depolarization triggered by acute or chronic superficial brain bleeding, a contributor to brain injury in other neurological diseases, may be the underlying mechanism. This review discusses diagnosis, pathophysiology, and management of CAA-related TFNEs.

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“…Because we did not do a prospective study, we cannot give an accurate prevalence for CAA-associated cSAH in a TIA clinic as not all TIA clinic patients in the control group underwent imaging if it was not clinically indicated. However, one recent paper suggested that this might be around 1% [8]. Our sample size remains small, with wide confidence intervals around the odds ratios for each presenting symptom.…”

Section: Discussionmentioning

confidence: 75%

Clinical features distinguish cerebral amyloid angiopathy-associated convexity subarachnoid haemorrhage from suspected TIA

et al. 2019

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Objective To identity clinical features that distinguish between cerebral amyloid angiopathy (CAA)-associated convexity subarachnoid haemorrhage (cSAH) and suspected TIA. Methods We undertook a single-centre, retrospective case-control study. We identified cases [patients with cSAH presenting with transient focal neurological episodes (TFNE)] from radiological and clinical databases of patients assessed at the National Hospital for Neurology and Neurosurgery and UCLH Comprehensive Stroke Service. We identified age-and gendermatched controls at a 1:4 ratio from a database of consecutive suspected TIA clinic attendances at UCLH. We compared presenting symptoms and vascular risk factors between cases and controls. Results We included 19 patients with cSAH-associated TFNE and 76 matched controls with suspected TIA. Migratory (spreading) symptoms (32% vs. 3%, OR 17.3; p = 0.001), sensory disturbance (47% vs. 14%, OR 5.3; p = 0.003,) and recurrent stereotyped events (47% vs. 19%, OR 3.7; p = 0.02,) occurred more frequently in patients with cSAH compared to controls. Hypercholesterolaemia was less common in patients with cSAH (16% vs 53%, OR 0.17; p = 0.008). Conclusion Simple clinical features could help distinguish cSAH-associated TFNE from suspected TIA, with relevance for investigation and management, including the use of antithrombotic drugs.

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Cerebral Microbleeds and Cortical Superficial Siderosis in Patients Presenting With Minor Cerebrovascular Events

Cited by 23 publications

References 27 publications

Corneal nerve and endothelial cell damage in patients with transient ischemic attack and minor ischemic stroke

Corneal nerve and endothelial cell damage in patients with transient ischemic attack and minor ischemic stroke

Cerebral Amyloid Angiopathy–Related Transient Focal Neurologic Episodes

Clinical features distinguish cerebral amyloid angiopathy-associated convexity subarachnoid haemorrhage from suspected TIA

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