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

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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 languageEnglish
Pages (from-to)710-717
JournalJournal of Cerebral Blood Flow and Metabolism
Volume35
Issue number5
DOIs
Publication statusPublished - 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