Convexity subarachnoid hemorrhage: clinical features and etiology of an Argentinian cohort

Abstract

Nontraumatic convexity subarachnoid hemorrhage is an increasingly recognized subtype of subarachnoid bleeding. Objective: Our aim was to describe the etiology and clinical features of a cohort of patients with convexity subarachnoid hemorrhage. Methods: We retrospectively analyzed all cases of convexity subarachnoid hemorrhage admitted to our hospital between January 2012 and April 2017. Demographic features, clinical characteristics, complementary investigations, etiology and mortality were assessed. Twenty patients (65% females) were identified. Mean age: 53 years (range, 15-86 years). Results: Symptoms on admission: headache (65%), sensory and/or motor symptoms (50%) and seizures (35%). Commonest causes: cerebral vein thrombosis (20%), reversible cerebral vasoconstriction syndrome (20%) and cerebral amyloid angiopathy (20%). Two patients died. Conclusion: Convexity subarachnoid hemorrhage may be related to a wide spectrum of etiologies. In our patients, an increased prevalence of cerebral vein thrombosis was observed. Mortality was low and not related to the bleeding itself.Keywords: cerebral amyloid angiopathy, etiology; sinus thrombosis, intracranial; subarachnoid hemorrhage. RESUMOA hemorragia subaracnóidea não traumática da convexidade é um subtipo cada vez mais reconhecido de sangramento subaracnóideo. Objetivo: Nosso objetivo foi descrever a etiologia e as características clínicas de uma coorte de pacientes com hemorragia subaracnóidea da convexidade. Métodos: Foram analisados retrospectivamente todos os casos de hemorragia subaracnóidea da convexidade admitidos em nosso hospital entre janeiro de 2012 e abril de 2017. Foram avaliados os aspectos demográficos, características clínicas, investigações complementares, etiologia e mortalidade. Vinte pacientes (65% mulheres) foram identificados. Média de idade: 53 anos (intervalo, 15-86). Resultados: Sintomas na admissão: dor de cabeça (65%), sintomas sensitivos e/ou motores (50%) e convulsões (35%). Causas mais comuns: trombose venosa cerebral (20%), síndrome de vasoconstrição cerebral reversível (20%) e angiopatia amilóide cerebral (20%). Dois pacientes morreram. Conclusão: A hemorragia subaracnóidea da convexidade pode estar relacionada a um amplo espectro de etiologias. Em nossos pacientes, observou-se uma maior prevalência de trombose venosa cerebral. A mortalidade foi baixa e não relacionada à própria hemorragia.Palavras-chave: angiopatia amiloide cerebral, etiologia; trombose dos seios intracranianos; hemorragia subaracnóidea.Nontraumatic nonaneurysmal convexity subarachnoid hemorrhage (cSAH) is an increasingly recognized subtype of subarachnoid bleeding localized in one or more cortical sulci of the brain without involvement of the neighboring parenchyma or extension to the interhemispheric fissure, basal cisterns or ventricles 1 . These features help to distinguish cSAH from aneurysmal bleeding and nontraumatic perimesencephalic subarachnoid hemorrhage. Recently, many case series have described the clinical features, etiology and outcome of t...

Cerebral Amyloid Angiopathy–Related Transient Focal Neurologic Episodes

“…23 Incidence of CAA-Related TFNEs The incidence of CAA-related TFNEs in the general population is unknown, owing to general underrecognition and a lack of consensus diagnostic criteria. Among patients with acute nontraumatic cSAH, CAA was identified as the cause in a quarter to a third of patients of all ages 11,[40][41][42][43][44][45][46][47] including 76% of persons 60 years of age or older. 40,46 Most of these patients with cSAH (≥75%) presented with TFNEs.…”

Reversible cerebral vasoconstriction syndrome presenting as convexity subarachnoid haemorrhage and posterior reversible encephalopathy syndrome during postpartum: a case report and literature review

“…Acute non-traumatic cSAH is increasingly recognized with at high risk of future symptomatic ICH [3], which may be attributed to a great number of etiologies. It was reported that besides intracranial aneurysm, RCVS and cerebral amyloid angiopathy (CAA) were also the common causes of cSAH [4][5][6]. As for posterior reversible encephalopathy syndrome (PRES), it is a clinico-radiological syndrome characterized by headache, seizures, mental disorder, visual loss and vasogenic edema predominantly affecting the posterior lobes of the brain [7].…”