Prevalence of cortical superficial siderosis in a memory clinic population

Zonneveld, Hazel I.; Goos, Jeroen; Wattjes, Mike P.; Prins, Niels D.; Scheltens, Philip; Flier, Wiesje M. van der; Kuijer, Joost P.A.; Muller, Majon; Barkhof, Frederik

doi:10.1212/wnl.0000000000000150

Cited by 73 publications

(67 citation statements)

References 43 publications

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“…In a retrospective thorough clinical and neuroimaging work-up of a single-center acute stroke cohort with a high availability of MRI within the first days of symptom onset, we found only 3 out of 298 IVT patients that had CSS (1%). The observed CSS prevalence in our stroke/IVT patients (mean age 68 years) ranges only slightly higher than the reported rate in an elderly non-demented general population of the Rotterdam Scan Study (0.7%) with a comparable mean age of 70 years [7] and considerably lower as opposed to cognitively impaired individuals from 2 European memory clinics (2.1 and 6.1%, mean ages of 66 and 74 years) [8,9] . Here, it is important to note that all 3 CSS patients in our cohort were functionally independent before the stroke index event and none of them had clinically overt cognitive impairment.…”

Section: Discussioncontrasting

confidence: 72%

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Cortical Superficial Siderosis and Risk of Bleeding after Thrombolysis for Ischemic Stroke

Gattringer¹,

Eppinger²,

Beitzke³

et al. 2015

Cerebrovasc Dis

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Background: Cortical superficial siderosis (CSS) is a neuroimaging marker of cerebral amyloid angiopathy and has been associated with a high risk for early subsequent major intracranial hemorrhage (ICH). Therefore, many experts recommend withholding of antithrombotic medication to patients with CSS. In this study, we sought to investigate the prevalence of CSS and the associated risk of ICH in the setting of intravenous thrombolysis (IVT) for ischemic stroke. Methods: We retrospectively searched the medical documentation system of our primary and tertiary care university clinic for all patients with ischemic stroke that received IVT from 2009 to December 2014. All available imaging data were reviewed in a standardized manner and blinded to any clinical data for the presence of CSS and ICH. CSS was defined as linear signal loss along the cerebral cortex on gradient echo T2*-weighted sequences. A stroke neurologist, who was blinded to the neuroimaging data, extracted the corresponding clinical data including follow-up information. Results: We identified 298 patients that received IVT and had undergone brain MRI (mean age 67.6 ± 12.6 years, 59.4% male). Cerebral MRI was performed in 116 patients (38.9%) before and in 182 patients (61.1%) after IVT (median time from stroke symptom onset to MRI: 1 day; range 0-7 days). Only 3 patients (2 females and 1 male aged 90, 76 and 73 years, respectively) had CSS (1%). All of them had a middle cerebral artery (MCA) stroke with a corresponding vessel occlusion. The 76-year-old female patient had extensive CSS and numerous cerebral microbleeds and received another IVT treatment for recurrent MCA stroke 8 months after the first event. After both IVTs, she had clinically asymptomatic small ICH outside the ischemic infarct and distant from CSS. The 2 other patients had only mild to moderate CSS and did not experience any ICH on postthrombolytic imaging. Conclusions: The prevalence of CSS in a clinical cohort of stroke patients that received IVT was low and thus does not appear to pose a substantial risk for symptomatic ICH although this may occur in individual patients. However, such analysis also needs to be extended to the very old stroke patients in whom IVT is increasingly used.

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Section: Discussioncontrasting

confidence: 72%

“…Therefore, many experts recommend withholding of antithrombotic medication to patients with CSS. While the prevalence of CSS in the elderly general population is estimated to be below 1% [7] , recent data from European memory clinic cohorts have indicated a higher frequency in patients with cognitive impairment (2-6%) [8,9].…”

Section: Introductionmentioning

confidence: 97%

Cortical Superficial Siderosis and Risk of Bleeding after Thrombolysis for Ischemic Stroke

Gattringer¹,

Eppinger²,

Beitzke³

et al. 2015

Cerebrovasc Dis

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“…A key question for future work will be whether CSO-PVS are an early marker of a CAA-related disease process, which ultimately leads to severe cortical and leptomeningeal amyloid deposition, with important implications for future hemorrhage risk. 11 Both cSS and PVS have been shown to be more prevalent in memory clinic patients (with Alzheimer disease or mild cognitive impairment) compared with healthy controls 31,[34][35][36] ; it would be interesting to investigate whether patients with cSS and CSO-PVS differ from those without these findings with regard to cognitive function. MRI-visible PVS are also common in the general population, especially with increased age 20,22,36,37 and might be related with worse cognitive function 14 and incident dementia.…”

Section: Discussionmentioning

confidence: 99%

White Matter Perivascular Spaces Are Related to Cortical Superficial Siderosis in Cerebral Amyloid Angiopathy

Charidimou

Jäger

Peeters

et al. 2014

Stroke

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Consecutive CAA patients (according to the original Boston criteria 9 ; ie, not including cSS as a criterion) from an ongoing multicenter Background and Purpose-We set out to investigate whether MRI-visible centrum semiovale perivascular spaces (CSO-PVS), a potential biomarker of impaired interstitial fluid drainage in sporadic cerebral amyloid angiopathy, is associated with cortical superficial siderosis (cSS), reflecting recurrent hemorrhage from severe leptomeningeal and superficial cortical vascular amyloid. Methods-Retrospective multicenter cohort study of possible/probable cerebral amyloid angiopathy according to the Boston criteria. PVS were rated in basal ganglia and CSO (CSO-PVS) on axial T2-weighted sequences, using a validated 4-point visual rating scale and were classified as high (score >2) or low degree (score ≤2) for prespecified analyses. Independent risk factors for high CSO-PVS degree were investigated in logistic regression. Results-The

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“…[3][4][5] Several studies showed that patients with cognitive impairment manifested a higher prevalence of cSS compared with the general population. 6,7 cSS, along with lobar cerebral microbleeds (MBs), was described as a characteristic neuroimaging marker of CAA. 8,9 Alzheimer disease (AD) is the most common cause of dementia in the elderly, and CAA is assumed to have a pivotal function in the underlying pathogenesis of AD.…”

mentioning

confidence: 99%

“…10 In the aforementioned studies, cSS was associated with the presence of MBs, and the authors speculated that a relatively high prevalence of cSS in patients with AD indicates this pathogenesis. 6,7 We therefore hypothesized that cSS itself may be a significant diagnostic marker of AD and that lobar MBs would be observed more frequently in patients with cSS than in patients without cSS. The primary aim of the present study was thus to clarify the diagnostic significance of cSS for AD, with the secondary aim being to explore the radiologic markers of small-vessel disease in relation to cSS in patients with cognitive impairment.…”

mentioning

confidence: 99%

Diagnostic Significance of Cortical Superficial Siderosis for Alzheimer Disease in Patients with Cognitive Impairment

Inoue¹,

Nakajima²,

Uetani³

et al. 2015

AJNR Am J Neuroradiol

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Prevalence of cortical superficial siderosis in a memory clinic population

Cited by 73 publications

References 43 publications

Cortical Superficial Siderosis and Risk of Bleeding after Thrombolysis for Ischemic Stroke

Cortical Superficial Siderosis and Risk of Bleeding after Thrombolysis for Ischemic Stroke

White Matter Perivascular Spaces Are Related to Cortical Superficial Siderosis in Cerebral Amyloid Angiopathy

Diagnostic Significance of Cortical Superficial Siderosis for Alzheimer Disease in Patients with Cognitive Impairment

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