Prevalence and clinical characteristics of cortical superficial siderosis in patients with acute stroke

Suda, Satoshi; Shimoyama, Takashi; Suzuki, Shizuka; Ouchi, Takahiro; Arakawa, Masafumi; Aoki, Junya; Suzuki, Kentaro; Sakamoto, Yuki; Okubo, Seiji; Nishiyama, Yasuhiro; Nito, Chikako; Mishina, Masayoshi; Kimura, Kazumi

doi:10.1007/s00415-017-8646-1

Cited by 13 publications

(7 citation statements)

References 26 publications

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“…cSS may be identified in 1% of patients with acute ischemic stroke. 34 cSS is associated with a high risk of subsequent intracerebral hemorrhage and is considered a highly specific finding of CAA. 14,15 We found cSS in 3% of our patients but only 4 had a disseminated cSS, the subtype with the highest risk of intracerebral hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation

et al. 2019

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ObjectiveWe tested the hypothesis that the risk of intracranial hemorrhage (ICH) in patients with cardioembolic ischemic stroke who are treated with oral anticoagulants (OAs) can be predicted by evaluating surrogate markers of hemorrhagic-prone cerebral angiopathies using a baseline MRI.MethodsPatients were participants in a multicenter and prospective observational study. They were older than 64 years, had a recent cardioembolic ischemic stroke, and were new users of OAs. They underwent a baseline MRI analysis to evaluate microbleeds, white matter hyperintensities, and cortical superficial siderosis. We collected demographic variables, clinical characteristics, risk scores, and therapeutic data. The primary endpoint was ICH that occurred during follow-up. We performed bivariate and multivariate Cox regression analyses.ResultsWe recruited 937 patients (aged 77.6 ± 6.5 years; 47.9% were men). Microbleeds were detected in 207 patients (22.5%), moderate/severe white matter hyperintensities in 419 (45.1%), and superficial siderosis in 28 patients (3%). After a mean follow-up of 23.1 ± 6.8 months, 18 patients (1.9%) experienced an ICH. In multivariable analysis, microbleeds (hazard ratio 2.7, 95% confidence interval [CI] 1.1–7, p = 0.034) and moderate/severe white matter hyperintensities (hazard ratio 5.7, 95% CI 1.6–20, p = 0.006) were associated with ICH (C index 0.76, 95% CI 0.66–0.85). Rate of ICH was highest in patients with both microbleed and moderate/severe WMH (3.76 per 100 patient-years, 95% CI 1.62–7.4).ConclusionPatients taking OAs who have advanced cerebral small vessel disease, evidenced by microbleeds and moderate to severe white matter hyperintensities, had an increased risk of ICH. Our results should help to determine the risk of prescribing OA for a patient with cardioembolic stroke.ClinicalTrials.gov identifierNCT02238470.

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Section: Discussionmentioning

confidence: 99%

MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation

et al. 2019

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“…23 Compared with CMBs, cSS is rare in the normal population. For example, in the population-based Rotterdam Scan Study, only 0.7% of the elderly populations had cSS; 31 in a Japanese cohort study, which evaluated the prevalence of cSS in acute stroke, 32 cSS was found in 1.0% of patients with ischemic 23 and SAH and subarachnoid extension of ICH underlie cSS. Notably, we found that hemorrhagic transformation after ischemic stroke accounted for approximately half of the cSS cases.…”

Section: Discussionmentioning

confidence: 99%

Association of Cortical Superficial Siderosis with Post‐Stroke Epilepsy

Fukuma

Abe

Matsubara

et al. 2022

Annals of Neurology

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Objective To assess whether post‐stroke epilepsy (PSE) is associated with neuroimaging findings of hemosiderin in a case–control study, and whether the addition of hemosiderin markers improves the risk stratification models of PSE. Methods We performed a post‐hoc analysis of the PROgnosis of POST‐Stroke Epilepsy study enrolling PSE patients at National Cerebral and Cardiovascular Center, Osaka, Japan, from November 2014 to September 2019. PSE was diagnosed when one unprovoked seizure was experienced >7 days after the index stroke, as proposed by the International League Against Epilepsy. As controls, consecutive acute stroke patients with no history or absence of any late seizure or continuing antiseizure medications at least 3 months after stroke were retrospectively enrolled during the same study period. We examined cortical microbleeds and cortical superficial siderosis (cSS) using gradient‐echo T2*‐weighted images. A logistic regression model with ridge penalties was tuned using 10‐fold cross‐validation. We added the item of cSS to the existing models (SeLECT and CAVE) for predicting PSE and evaluated performance of new models. Results The study included 180 patients with PSE (67 women; median age 74 years) and 1,183 controls (440 women; median age 74 years). The cSS frequency was higher in PSE than control groups (48.9% vs 5.7%, p < 0.0001). Compared with the existing models, the new models with cSS (SeLECT‐S and CAVE‐S) demonstrated significantly better predictive performance of PSE (net reclassification improvement 0.63 [p = 0.004] for SeLECT‐S and 0.88 [p = 0.001] for CAVE‐S at the testing data). Interpretation Cortical superficial siderosis was associated with PSE, stratifying stroke survivors at high risk of PSE. ANN NEUROL 2023;93:357–370

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“…High brain natriuretic peptide (BNP) or N-terminal pro B-type natriuretic peptide (NT-proBNP) levels were defined as >100 or >300 pg/mL, respectively ( 25 , 26 ). Gradient-recalled echo T2*-weighted images were assessed for evidence of cerebral microbleeds (CMBs), defined as parenchymal hemorrhage ≤10 mm in diameter ( 27 ). Stroke severity on admission and on discharge was assessed using the National Institutes of Health Stroke Scale (NIHSS) score and the mRS score, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Gradient-recalled echo T2*-weighted images were assessed for evidence of cerebral microbleeds (CMBs), defined as parenchymal hemorrhage ! 10 mm in diameter (27). Stroke severity on admission and on discharge was assessed using the National Institutes of Health Stroke Scale (NIHSS) score and the mRS score, respectively.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

Characteristics of Ischemic Versus Hemorrhagic Stroke in Patients Receiving Oral Anticoagulants: Results of the PASTA Study

et al. 2022

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Objective Limited data exist regarding the comparative detailed clinical characteristics of patients with ischemic stroke (IS)/transient ischemic attack (TIA) and intracerebral hemorrhage (ICH) receiving oral anticoagulants (OACs). Methods The prospective analysis of stroke patients taking oral anticoagulants (PASTA) registry, a multicenter registry of 1,043 stroke patients receiving OACs (vitamin K antagonists [VKAs] or non-vitamin K oral antagonists [NOACs]) across 25 medical institutions throughout Japan, was used. Univariate and multivariable analyses were used to analyze differences in clinical characteristics between IS/TIA and ICH patients with atrial fibrillation (AF) who were registered in the PASTA registry. Results There was no significant differences in cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, smoking, or alcohol consumption (all p>0.05), between IS/TIA and ICH among both NOAC and VKA users. Cerebral microbleeds (CMBs) (odds ratio [OR], 4.77; p<0.0001) were independently associated with ICH, and high brain natriuretic peptide/N-terminal pro B-type natriuretic peptide levels (OR, 1.89; p=0.0390) were independently associated with IS/TIA among NOAC users. A history of ICH (OR, 13.59; p=0.0279) and the high prothrombin time-international normalized ratio (PT-INR) (OR, 1.17; p< 0.0001) were independently associated with ICH, and a history of IS/TIA (OR, 3.37; 95% CI, 1.34-8.49; p= 0.0101) and high D-dimer levels (OR, 2.47; 95% CI, 1.05-5.82; p=0.0377) were independently associated with IS/TIA among VKA users.

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Prevalence and clinical characteristics of cortical superficial siderosis in patients with acute stroke

Cited by 13 publications

References 26 publications

MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation

MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation

Association of Cortical Superficial Siderosis with Post‐Stroke Epilepsy

Characteristics of Ischemic Versus Hemorrhagic Stroke in Patients Receiving Oral Anticoagulants: Results of the PASTA Study

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