Their baseline clinical and imaging characteristics were not different from those who had T2*-GRE (data not shown).Īll MRIs were reviewed by the investigators, who were blinded to the baseline clinical data and follow-up information, according to the Standards for Reporting Vascular Changes on Neuroimaging. 22 A small subset of patients (n = 15, 5.7%) underwent susceptibility-weighted imaging (SWI) instead of T2*-GRE as the blood-sensitive sequence. Images were acquired on a 1.5T scanner and included at least T2*-weighted gradient recalled echo (T2*-GRE) and FLAIR sequences, as previously detailed. We investigated whether cSAH associated with acute lobar ICH is a predictor of ICH recurrence in patients with CAA. In this prospective cohort study, we aimed to determine the prognostic relevance of cSAH in patients with CAA-ICH. 9, 10, 16, – 19 Whether cSAH heralds an increased risk of recurrent ICH in patients with CAA-ICH remains unknown. 15 Hence, cSAH might be a marker of vascular fragility, especially because cortical superficial siderosis (cSS), the chronic form of superficial bleeding in CAA resulting from episodes of acute cSAH, is a major risk factor for future ICH. Recently, the presence of cSAH associated with lobar ICH has been linked to underlying CAA, 13, 14 raising the possibility that cSAH may be caused by the rupture of leptomeningeal vessels, affected predominantly in CAA. 8 However, future ICH risk appears heterogeneous in patients with CAA, 9, – 11 and accurately stratifying this risk may guide clinical management of these patients.Ĭonvexity subarachnoid hemorrhage (cSAH) is sometimes observed simultaneously with lobar ICH 12 and was thought to result from extension to a parenchymal hemorrhage into the subarachnoid space. 4, 5 Despite preventive strategies, including tight blood pressure control 6 and bleeding risk–based anticoagulant strategy, 7the risk of recurrent ICH is high in patients with CAA-related ICH (CAA-ICH).
Cerebral amyloid angiopathy (CAA) is the most important cause of lobar intracerebral hemorrhage (ICH) in the elderly, 1 a devastating disease characterized by high mortality rate, 2 poor functional outcome, 3 and dementia.
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