Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course

Refai, Daniel; Botros, James A.; Strom, Russell G.; Derdeyn, Colin P.; Sharma, Aseem; Zipfel, Gregory J.

doi:10.3171/jns.2008.109.12.1034

Cited by 86 publications

(57 citation statements)

References 40 publications

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“…Traumatic SAH was excluded. Convexity type SAH was also excluded by consensus because it is usually secondary to defined pathologies with different diagnostic and treatment protocols 38,49 . From the 1.149 total cases, 929 (81%) were aneurismal SAH (ANSAH), including 55 patients who died before angiography.…”

Section: Methodsmentioning

confidence: 99%

Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

et al. 2010

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SummaryBackground. The Spanish neurosurgical society created a multicentre data base on spontaneous SAH to analyze the real problematic of this disease in our country. This paper focuses on the group of patients with idiopathic SAH (ISAH).Methods. 16 participant hospitals collect their spontaneous SAH cases in a common data base shared in the internet through a secured web page, considering clinical, radiological, evolution and outcome variables. The 220 ISAH cases collected from November 2004 to November 2007 were statistically analyzed as a whole and divided into 3 subgroups depending on the CT blood pattern (aneurysmal, perimesencephalic, or normal).Results. Resultados. Los 220 pacientes con HSAI representan el 19% del total de 1.149 pacientes con HSA recogidos en la base de datos en el mismo periodo.El 46,8% de los casos de HSAI presentaron patrón de sangrado aneurismático en TC, hecho que se correlacionó con mayor edad, peor condición clínica al ingreso, mayor grado Fisher de sangrado, más frecuencia de hidrocefalia y peor evolución, comparados con los casos de HSAI con sangrado en TC del tipo perimesencefálico (42,7%) o con TC normal (10,4%).Una vez superada la fase aguda, e independientemente del tipo de sangrado inicial, la evolución de los pacientes con HSAI es globalmente buena y significativamente mejor que la de los pacientes con HSA aneurismática. La única variable con valor pronóstico en los casos de HSAI, tras realizar un análisis de Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

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Section: Methodsmentioning

confidence: 99%

Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

et al. 2010

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“…DISCUSSION To our knowledge, the current report represents the largest cohort of patients with cSAH in existing literature. Two recent smaller case series have been published on this topic; one employed a similar methodology to ours and retrospectively identified 20 cases of cSAH from a radiologic database 10 whereas another 9 reported on 12 cases seen at a neurology clinic. Detailed clinical descriptions were not provided in these reports.…”

Section: Recurrent Hemorrhage (Intracerebral Hemorrhage)mentioning

confidence: 99%

“…In the larger series comprising 20 patients, 10 15 (75%) presented with headaches and 6 had thunderclap headaches; 8 underwent conventional angiograms, revealing vasoconstriction in 5 patients. The smaller case series 9 reported headaches in 6 out of 12 patients of which 3 had thunderclap headaches; 4 underwent angiograms, demonstrating vasoconstriction in 1 and delayed filling of distal cortical arteries in 2 patients.…”

Section: Recurrent Hemorrhage (Intracerebral Hemorrhage)mentioning

confidence: 99%

“…Diverse etiologies have been posited for its occurrence, including cortical vein occlusions, posterior reversible leukoencephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), coagulopathy, cocaine use, lupus vasculitis, cavernoma, brain abscesses, and cerebral amyloid angiopathy (CAA). [1][2][3][4][5][6][7][8][9][10][11][12][13] Existing information about this condition is largely derived from case reports and small case series, which carry inherent referral and diagnostic biases. We undertook this study to systematically evaluate and review the potential causes and patterns of clinical and radiologic presentation of localized cSAH from the inpatient population at our institution.…”

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confidence: 99%

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Atraumatic convexal subarachnoid hemorrhage

Kumar¹,

Goddeau²,

Selim³

et al. 2010

Neurology

252

146

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Objective: To identify patterns of clinical presentation, imaging findings, and etiologies in a cohort of hospitalized patients with localized nontraumatic convexal subarachnoid hemorrhage.Methods: Twenty-nine consecutive patients with atraumatic convexal subarachnoid hemorrhage were identified using International Classification of Diseases-9 code from 460 patients with subarachnoid hemorrhage evaluated at our institution over a course of 5 years. Retrospective review of patient medical records, neuroimaging studies, and follow-up data was performed.Results: There were 16 women and 13 men between the ages of 29 and 87 years. Two common patterns of presentations were observed. The most frequent presenting symptom in patients Յ60 years (n ϭ 16) was a severe headache (n ϭ 12; 75%) of abrupt onset (n ϭ 9; 56%) with arterial narrowing on conventional angiograms in 4 patients; 10 (p ϭ 0.003) were presumptively diagnosed with a primary vasoconstriction syndrome. Patients Ͼ60 years (n ϭ 13) usually had temporary sensory or motor symptoms (n ϭ 7; 54%); brain MRI scans in these patients showed evidence of leukoaraiosis and/or hemispheric microbleeds and superficial siderosis (n ϭ 9; 69%), compatible with amyloid angiopathy (n ϭ 10; p Ͻ 0.0001). In a small group of patients, the presentation was more varied and included lethargy, fever, and confusion. Four patients older than 60 years had recurrent intracerebral hemorrhages in the follow-up period with 2 fatalities. Conclusion:Convexal subarachnoid hemorrhage is an important subtype of nonaneurysmal subarachnoid bleeding with diverse etiologies, though a reversible vasoconstriction syndrome appears to be a common cause in patients 60 years or younger whereas amyloid angiopathy is frequent in patients over 60. These observations require confirmation in future studies. Atraumatic localized convexal subarachnoid hemorrhage (cSAH) is an unusual presentation of subarachnoid bleeding, in which the bleeding is localized to the convexities of the brain without involvement of the adjacent parenchyma or extension into the interhemispheric fissures, basal cisterns, or ventricles. Since most saccular aneurysms arise from the circle of Willis, aneurysmal rupture is an unlikely source of cSAH. Diverse etiologies have been posited for its occurrence, including cortical vein occlusions, posterior reversible leukoencephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), coagulopathy, cocaine use, lupus vasculitis, cavernoma, brain abscesses, and cerebral amyloid angiopathy (CAA). 1-13Existing information about this condition is largely derived from case reports and small case series, which carry inherent referral and diagnostic biases. We undertook this study to systematically evaluate and review the potential causes and patterns of clinical and radiologic presentation of localized cSAH from the inpatient population at our institution.

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“…Spontaneous acute cSAH observed at the convexity of the brain is a relatively rare entity, seldom described, [2][3][4] with various vascular and nonvascular causes, including the following: CVT (both dural and cortical), 5,6 vascular malformations (pial arteriovenous malformations, dural arteriovenous fistulas, and cavernomas), RCVS, 7 vasculitides, 8,9 infectious aneurysms, 10 Moyamoya disease or syndrome, 11 severe atherosclerotic carotid disease, PRES, 12 CAA, 13 and nonvascular disorders, such as primary and secondary brain neoplasms [14][15][16] or even abscess (Table). 17 The purposes of this work were the following: first to propose a diagnostic work-up that covers the wide spectrum of potential underlying causes of cSAH and then to review the specific findings of each etiology that may be responsible for cSAH.…”

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confidence: 99%

Isolated Acute Nontraumatic Cortical Subarachnoid Hemorrhage

Cuvinciuc¹,

Viguier²,

Calvière³

et al. 2010

AJNR Am J Neuroradiol

129

108

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SUMMARY:Our aim was to review the etiologic background of isolated acute nontraumatic cSAH. While SAH located in the basal cisterns originates from a ruptured aneurysm in approximately 85% of cases, a broad spectrum of vascular and even nonvascular pathologies can cause acute nontraumatic SAH along the convexity. Arteriovenous malformations or fistulas, cortical venous and/or dural sinus thrombosis, and distal and proximal arteriopathies (RCVS, vasculitides, mycotic aneurysms, Moyamoya, or severe atherosclerotic carotid disease) should be sought by noninvasive imaging methods or/and conventional angiography. Additionally, PRES may also be a source of acute cSAH. In elderly patients, cSAH might be attributed to CAA if numerous hemorrhages are demonstrated by GRE T2 images. Finally, cSAH is rarely observed in nonvascular disorders, such as abscess and primitive or secondary brain tumors.ABBREVIATIONS: CAA ϭ cerebral amyloid angiopathy; cSAH ϭ cortical subarachnoid hemorrhage; CTA ϭ CT angiography; CTV ϭ CT venography; CVT ϭ cerebral venous thrombosis; DSA ϭ digital subtraction angiography; DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; Gd ϭ gadolinium; GRE T2 ϭ gradient echo T2-weighted imaging; MRA ϭ MR angiography; MRV ϭ MR venography; PRES ϭ posterior reversible encephalopathy syndrome; RCVS ϭ reversible cerebral vasoconstriction syndrome; SAH ϭ subarachnoid hemorrhage; SWI ϭ susceptibility-weighted imaging; TIA ϭ transient ischemic attack; TOF ϭ time of flight N ontraumatic (spontaneous) SAH arises in approximately 85% of cases from rupture of a saccular aneurysm at the base of the brain. Nonaneurysmal perimesencephalic hemorrhages account for another 10%.

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Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course

Abstract: Spontaneous isolated convexity SAH is rarely caused by aneurysm rupture, has a distinct mode of presentation, and generally carries a more favorable prognosis than that of aneurysmal SAH.

Cited by 86 publications

References 40 publications

Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

Atraumatic convexal subarachnoid hemorrhage

Isolated Acute Nontraumatic Cortical Subarachnoid Hemorrhage

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