Cortical superficial siderosis and acute convexity subarachnoid hemorrhage in cerebral amyloid angiopathy

Raposo, Nicolas; Calvière, Lionel; Cazzola, Vanessa; Planton, Mélanie; Patsoura, Sofia; Wargny, Matthieu; Albucher, Jean François; Sommet, Agnès; Olivot, Jean Marc; Chollet, François; Pariente, Jérémie; Bonneville, Fabrice; Viguier, Alain

doi:10.1111/ene.13484

Cited by 19 publications

(18 citation statements)

References 24 publications

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“…Two cohort studies showed that the majority of patients with CAA-related TFNEs (first ever or recurrent) have one or both of cSAH or cSS (58% 5 and 83% 13 , respectively). Disseminated cSS is much more common in CAA patients presenting with TFNEs than CAA patients presenting with ICH 15,16 .…”

Section: Neuroimagingmentioning

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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Section: Neuroimagingmentioning

confidence: 99%

Cerebral Amyloid Angiopathy–Related Transient Focal Neurologic Episodes

et al. 2021

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“…We investigated the clinical and imaging factors associated with mixed CMB compared to strictly lobar CMB (suggesting CAA) and strictly deep CMB (suggesting HA). We also evaluated whether CMB distribution in patients with mixed CMB may indicate underlying SVD by testing the associations of the ratio lobar / total CMB count with symptomatic lobar ICH and cortical superficial siderosis (cSS), key neuroimaging markers of CAA (7, 9, 10).…”

Section: Introductionmentioning

confidence: 99%

Underlying Small Vessel Disease Associated With Mixed Cerebral Microbleeds

et al. 2019

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Background and Purpose: Whether patients with both lobar and deep cerebral microbleeds (mixed CMB) have advanced cerebral amyloid angiopathy (CAA), hypertensive angiopathy (HA) or both is uncertain. To get insight into the underlying small vessel disease (SVD) associated with mixed CMB, we explored its association with cortical superficial siderosis (cSS), a key marker of CAA and other MRI markers of SVD in patients with intracerebral hemorrhage (ICH).Methods: Of 425 consecutive patients with acute ICH who had received brain MRIs, 260 had ≥1 CMB and were included in the analysis. They were categorized as strictly lobar CMB (suggesting CAA), strictly deep CMB (suggesting HA) or mixed CMB. Clinical and imaging characteristics were compared (1) between the three CMB groups and (2) within mixed CMB patients according to the symptomatic ICH location.Results: Overall, 111 (26%) patients had mixed CMB. Compared to strictly lobar CMB (n = 111) and strictly deep CMB (n = 38), patients with mixed CMB had a more severe burden of lacune, white matter hyperintensities and CMB. cSS was observed in 24.3% of patients with mixed CMB compared to 44.1% in strictly lobar CMB and 10.5% in strictly deep CMB (p < 0.0001). Among patients with mixed CMB, 44 (39.6%) had a lobar symptomatic ICH and 67 (60.4%) had a non-lobar ICH. Patients with non-lobar ICH were more likely to have hypertension, whereas those with lobar ICH were more likely to have cSS and chronic lobar ICH and had higher ratio lobar CMB count/total CMB count.Conclusions: Mixed CMB is frequently encountered in patients with ICH and appears as a heterogeneous group, suggesting that both CAA and HA may be contributing to mixed CMB. Neuroimaging markers including ICH location, cSS, and CMB distribution may indicate the predominant underlying vasculopathy, with potential prognostic implications.

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“…The presented case was CAA-related ICH accompanied by massive SAH, although the volume of parenchymal haematoma was relatively small (Patel et al, 2009 ). Severe SAH resembling that of aneurysmal origin is rare in CAA (Ohshima et al, 1990 ; Charidimou et al, 2015 ; Ni et al, 2015 ; Raposo et al, 2018 ). Old age and pancreatic cancer may have exacerbated the bleeding from the Aβ-positive vessels into the subarachnoid space.…”

Section: Discussionmentioning

confidence: 99%

“…Bleeding into the subarachnoid space is also common in CAA, presenting as convexity subarachnoid haemorrhage (SAH) in acute and superficial siderosis in the chronic phase. However, CAA is seldom described as a cause of massive SAH resembling aneurysmal rupture (Ohshima et al, 1990 ; Charidimou et al, 2015 ; Ni et al, 2015 ; Raposo et al, 2018 ). Here, we report an autopsied case of widespread SAH related to CAA.…”

Section: Introductionmentioning

confidence: 99%