Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: An ARIA before the tsunami

Eva Martínez-Lizana; María Carmona-Iragui; Daniel Alcolea; Manuel Gómez-Choco; Eduard Vilaplana; María B. Sánchez-Saudinós; Jordi Clarimón; Mar Hernández-Guillamon; Josep Munuera; Ellen Gelpi; Beatriz Gómez-Anson; Manel De Juan-Delago; Raquel Delgado-Mederos; Joan Montaner; Angel Ois; Sergi Amaro; Rafael Blesa; Joan Martí-Fàbregas; Alberto Lleó; Juan Fortea

doi:10.1038/jcbfm.2015.25

Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: An ARIA before the tsunami

Eva Martínez-Lizana, María Carmona-Iragui, Daniel Alcolea, Manuel Gómez-Choco, Eduard Vilaplana, María B. Sánchez-Saudinós, Jordi Clarimón, Mar Hernández-Guillamon, Josep Munuera, Ellen Gelpi, Beatriz Gómez-Anson, Manel De Juan-Delago, Raquel Delgado-Mederos, Joan Montaner, Angel Ois, Sergi Amaro, Rafael Blesa, Joan Martí-Fàbregas, Alberto Lleó, Juan Fortea

Department of Medicine

Research output: Contribution to journal › Article › Research › peer-review

15 Citations (Scopus)

Abstract

© 2015 ISCBFM. Atraumatic convexal subarachnoid hemorrhage (cSAH) in elderly patients is a rare entity that has been associated with cerebral amyloid angiopathy (CAA) and intracerebral hematomas (ICH). To characterize this entity and to study these associations, 22 patients over 60 with cSAH were included in a multicenter ambispective cohort study. Clinical data, magnetic resonance imaging (MRI) studies, APOE genotyping, and cerebrospinal fluid (CSF) biomarkers were evaluated. Results were compared with data from healthy controls (HC), non-cSAH CAA patients (CAAo), and Alzheimer disease patients. Convexal subarachnoid hemorrhage presented with transient sensory or motor symptoms. At follow-up (median 30.7 months), 5 patients had died, 6 survivors showed functional disability (modified Rankins Scale (mRS)>2), and 12 cognitive impairment. Four patients had prior ICH and six had an ICH during follow-up. CSF-Aß40 and Aß42 levels were lower in cSAH and CAAo compared with HC. Convexal subarachnoid hemorrhage presented an APOE-ε2 overrepresentation and CAAo had an APOE-ε4 overrepresentation. On MRI, all patients fulfilled CAA-modified Boston criteria and 9 showed cortical ischemia in the surrounding cortex or the vicinity of superficial siderosis. The neuropathologic study, available in one patient, showed severe CAA and advanced Alzheimer-type pathology. Convexal subarachnoid hemorrhage in the elderly is associated with cognitive impairment and lobar ICH occurrence. Our findings support the existence of an underlying CAA pathology.

Original language	English
Pages (from-to)	710-717
Journal	Journal of Cerebral Blood Flow and Metabolism
Volume	35
Issue number	5
DOIs	https://doi.org/10.1038/jcbfm.2015.25
Publication status	Published - 1 Jan 2015

Keywords

APOE
biomarkers
cerebral amyloid angiopathy
lobar hemorrhage
subarachnoid hemorrhage

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Martínez-Lizana, E., Carmona-Iragui, M., Alcolea, D., Gómez-Choco, M., Vilaplana, E., Sánchez-Saudinós, M. B., Clarimón, J., Hernández-Guillamon, M., Munuera, J., Gelpi, E., Gómez-Anson, B., De Juan-Delago, M., Delgado-Mederos, R., Montaner, J., Ois, A., Amaro, S., Blesa, R., Martí-Fàbregas, J., Lleó, A., & Fortea, J. (2015). Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: An ARIA before the tsunami. Journal of Cerebral Blood Flow and Metabolism, 35(5), 710-717. https://doi.org/10.1038/jcbfm.2015.25

Martínez-Lizana, Eva ; Carmona-Iragui, María ; Alcolea, Daniel ; Gómez-Choco, Manuel ; Vilaplana, Eduard ; Sánchez-Saudinós, María B. ; Clarimón, Jordi ; Hernández-Guillamon, Mar ; Munuera, Josep ; Gelpi, Ellen ; Gómez-Anson, Beatriz ; De Juan-Delago, Manel ; Delgado-Mederos, Raquel ; Montaner, Joan ; Ois, Angel ; Amaro, Sergi ; Blesa, Rafael ; Martí-Fàbregas, Joan ; Lleó, Alberto ; Fortea, Juan. / Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: An ARIA before the tsunami. In: Journal of Cerebral Blood Flow and Metabolism. 2015 ; Vol. 35, No. 5. pp. 710-717.

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title = "Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: An ARIA before the tsunami",

abstract = "{\textcopyright} 2015 ISCBFM. Atraumatic convexal subarachnoid hemorrhage (cSAH) in elderly patients is a rare entity that has been associated with cerebral amyloid angiopathy (CAA) and intracerebral hematomas (ICH). To characterize this entity and to study these associations, 22 patients over 60 with cSAH were included in a multicenter ambispective cohort study. Clinical data, magnetic resonance imaging (MRI) studies, APOE genotyping, and cerebrospinal fluid (CSF) biomarkers were evaluated. Results were compared with data from healthy controls (HC), non-cSAH CAA patients (CAAo), and Alzheimer disease patients. Convexal subarachnoid hemorrhage presented with transient sensory or motor symptoms. At follow-up (median 30.7 months), 5 patients had died, 6 survivors showed functional disability (modified Rankins Scale (mRS)>2), and 12 cognitive impairment. Four patients had prior ICH and six had an ICH during follow-up. CSF-A{\ss}40 and A{\ss}42 levels were lower in cSAH and CAAo compared with HC. Convexal subarachnoid hemorrhage presented an APOE-ε2 overrepresentation and CAAo had an APOE-ε4 overrepresentation. On MRI, all patients fulfilled CAA-modified Boston criteria and 9 showed cortical ischemia in the surrounding cortex or the vicinity of superficial siderosis. The neuropathologic study, available in one patient, showed severe CAA and advanced Alzheimer-type pathology. Convexal subarachnoid hemorrhage in the elderly is associated with cognitive impairment and lobar ICH occurrence. Our findings support the existence of an underlying CAA pathology.",

keywords = "APOE, biomarkers, cerebral amyloid angiopathy, lobar hemorrhage, subarachnoid hemorrhage",

author = "Eva Mart{\'i}nez-Lizana and Mar{\'i}a Carmona-Iragui and Daniel Alcolea and Manuel G{\'o}mez-Choco and Eduard Vilaplana and S{\'a}nchez-Saudin{\'o}s, {Mar{\'i}a B.} and Jordi Clarim{\'o}n and Mar Hern{\'a}ndez-Guillamon and Josep Munuera and Ellen Gelpi and Beatriz G{\'o}mez-Anson and {De Juan-Delago}, Manel and Raquel Delgado-Mederos and Joan Montaner and Angel Ois and Sergi Amaro and Rafael Blesa and Joan Mart{\'i}-F{\`a}bregas and Alberto Lle{\'o} and Juan Fortea",

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doi = "10.1038/jcbfm.2015.25",

language = "English",

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pages = "710--717",

journal = "Journal of Cerebral Blood Flow and Metabolism",

issn = "0271-678X",

number = "5",

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Martínez-Lizana, E, Carmona-Iragui, M, Alcolea, D, Gómez-Choco, M, Vilaplana, E, Sánchez-Saudinós, MB, Clarimón, J, Hernández-Guillamon, M, Munuera, J, Gelpi, E, Gómez-Anson, B, De Juan-Delago, M, Delgado-Mederos, R, Montaner, J, Ois, A, Amaro, S, Blesa, R , Martí-Fàbregas, J , Lleó, A & Fortea, J 2015, 'Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: An ARIA before the tsunami', Journal of Cerebral Blood Flow and Metabolism, vol. 35, no. 5, pp. 710-717. https://doi.org/10.1038/jcbfm.2015.25

Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: An ARIA before the tsunami. / Martínez-Lizana, Eva; Carmona-Iragui, María; Alcolea, Daniel; Gómez-Choco, Manuel; Vilaplana, Eduard; Sánchez-Saudinós, María B.; Clarimón, Jordi; Hernández-Guillamon, Mar; Munuera, Josep; Gelpi, Ellen; Gómez-Anson, Beatriz; De Juan-Delago, Manel; Delgado-Mederos, Raquel; Montaner, Joan; Ois, Angel; Amaro, Sergi; Blesa, Rafael ; Martí-Fàbregas, Joan ; Lleó, Alberto; Fortea, Juan.

In: Journal of Cerebral Blood Flow and Metabolism, Vol. 35, No. 5, 01.01.2015, p. 710-717.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: An ARIA before the tsunami

AU - Martínez-Lizana, Eva

AU - Carmona-Iragui, María

AU - Alcolea, Daniel

AU - Gómez-Choco, Manuel

AU - Vilaplana, Eduard

AU - Sánchez-Saudinós, María B.

AU - Clarimón, Jordi

AU - Hernández-Guillamon, Mar

AU - Munuera, Josep

AU - Gelpi, Ellen

AU - Gómez-Anson, Beatriz

AU - De Juan-Delago, Manel

AU - Delgado-Mederos, Raquel

AU - Montaner, Joan

AU - Ois, Angel

AU - Amaro, Sergi

AU - Blesa, Rafael

AU - Martí-Fàbregas, Joan

AU - Lleó, Alberto

AU - Fortea, Juan

PY - 2015/1/1

Y1 - 2015/1/1

N2 - © 2015 ISCBFM. Atraumatic convexal subarachnoid hemorrhage (cSAH) in elderly patients is a rare entity that has been associated with cerebral amyloid angiopathy (CAA) and intracerebral hematomas (ICH). To characterize this entity and to study these associations, 22 patients over 60 with cSAH were included in a multicenter ambispective cohort study. Clinical data, magnetic resonance imaging (MRI) studies, APOE genotyping, and cerebrospinal fluid (CSF) biomarkers were evaluated. Results were compared with data from healthy controls (HC), non-cSAH CAA patients (CAAo), and Alzheimer disease patients. Convexal subarachnoid hemorrhage presented with transient sensory or motor symptoms. At follow-up (median 30.7 months), 5 patients had died, 6 survivors showed functional disability (modified Rankins Scale (mRS)>2), and 12 cognitive impairment. Four patients had prior ICH and six had an ICH during follow-up. CSF-Aß40 and Aß42 levels were lower in cSAH and CAAo compared with HC. Convexal subarachnoid hemorrhage presented an APOE-ε2 overrepresentation and CAAo had an APOE-ε4 overrepresentation. On MRI, all patients fulfilled CAA-modified Boston criteria and 9 showed cortical ischemia in the surrounding cortex or the vicinity of superficial siderosis. The neuropathologic study, available in one patient, showed severe CAA and advanced Alzheimer-type pathology. Convexal subarachnoid hemorrhage in the elderly is associated with cognitive impairment and lobar ICH occurrence. Our findings support the existence of an underlying CAA pathology.

AB - © 2015 ISCBFM. Atraumatic convexal subarachnoid hemorrhage (cSAH) in elderly patients is a rare entity that has been associated with cerebral amyloid angiopathy (CAA) and intracerebral hematomas (ICH). To characterize this entity and to study these associations, 22 patients over 60 with cSAH were included in a multicenter ambispective cohort study. Clinical data, magnetic resonance imaging (MRI) studies, APOE genotyping, and cerebrospinal fluid (CSF) biomarkers were evaluated. Results were compared with data from healthy controls (HC), non-cSAH CAA patients (CAAo), and Alzheimer disease patients. Convexal subarachnoid hemorrhage presented with transient sensory or motor symptoms. At follow-up (median 30.7 months), 5 patients had died, 6 survivors showed functional disability (modified Rankins Scale (mRS)>2), and 12 cognitive impairment. Four patients had prior ICH and six had an ICH during follow-up. CSF-Aß40 and Aß42 levels were lower in cSAH and CAAo compared with HC. Convexal subarachnoid hemorrhage presented an APOE-ε2 overrepresentation and CAAo had an APOE-ε4 overrepresentation. On MRI, all patients fulfilled CAA-modified Boston criteria and 9 showed cortical ischemia in the surrounding cortex or the vicinity of superficial siderosis. The neuropathologic study, available in one patient, showed severe CAA and advanced Alzheimer-type pathology. Convexal subarachnoid hemorrhage in the elderly is associated with cognitive impairment and lobar ICH occurrence. Our findings support the existence of an underlying CAA pathology.

KW - APOE

KW - biomarkers

KW - cerebral amyloid angiopathy

KW - lobar hemorrhage

KW - subarachnoid hemorrhage

U2 - 10.1038/jcbfm.2015.25

DO - 10.1038/jcbfm.2015.25

M3 - Article

VL - 35

SP - 710

EP - 717

JO - Journal of Cerebral Blood Flow and Metabolism

JF - Journal of Cerebral Blood Flow and Metabolism

SN - 0271-678X

IS - 5

ER -