Teaching NeuroImages: Acute convexity subarachnoid hemorrhage

Theodorou, Aikaterini; Lachanis, Stefanos; Alexopoulos, Palaiologos; Palaiodimou, Lina; Kollia, Nikoletta; Voumvourakis, Konstantinos; Tsivgoulis, Georgios

doi:10.1212/wnl.0000000000007873

Neurology

2019

DOI: 10.1212/wnl.0000000000007873

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Teaching NeuroImages: Acute convexity subarachnoid hemorrhage

Aikaterini Theodorou

Stefanos Lachanis

Palaiologos Alexopoulos

et al.

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Cited by 3 publications

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“…Excluding injuries and iatrogenic factors, common causes of spontaneous SAH include aneurysms, cavernous haemangioma, venous thrombosis, arteriovenous malformations and cerebral arteriovenous fistula,8 cerebral amyloid angiopathy,9–11 tumour bleeding, special vasculitis/encephalitis10 and abnormal blood coagulation 12. Rare causes of SAH include postpartum eclampsia and reversible cerebral vasoconstriction syndrome 9.…”

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confidence: 99%

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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of spontaneous subarachnoid haemorrhage

Dong

Guo

et al. 2019

Stroke Vasc Neurol

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AimSpontaneous subarachnoid haemorrhage (SAH) caused by ruptured cerebral aneurysm is a severe subtype of haemorrhagic stroke. Although the incidence of SAH is relatively low among all cerebrovascular diseases, the mortality is the highest. The critical management of SAH is challenging. We provide this evidence-based guideline to present current and comprehensive recommendations for the diagnosis and treatment of non-trauma SAH.MethodsA formal literature search of MEDLINE (1 January 1990–30 June 2019) was performed. Data were synthesised with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The Chinese Stroke Association’s levels of evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by Chinese Stroke Association’s Stroke Fellow Committees. It is intended that this guideline be fully updated every 3 years.ResultsEvidence-based guidelines are presented for the care of patients presenting with non-trauma SAH. The focus of the guideline was subdivided into transfer and systems of care, diagnosis flowchart, aetiology and differentiation, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, management of vasospasm and delayed cerebral ischaemia, management of hydrocephalus, management of seizures and management of medical complications.ConclusionsThe guideline offers a framework for SAH management. Early professional and aggressive care of SAH might help dramatically.

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“…According to the anatomical site that a SAH develops and is seen on head CT scan, SAH is classified into convex SAH and non-convex SAH. The former is more common in venous system embolism, venous sinus thrombosis and cerebral amyloid angiopathy,10 11 while the latter is more common in aneurysmal rupture.…”

mentioning

confidence: 99%

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of spontaneous subarachnoid haemorrhage

Dong

Guo

et al. 2019

Stroke Vasc Neurol

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Early MRI imaging and follow-up study in cerebral amyloid angiopathy

et al. 2021

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Aim To study the imaging features of leukoaraiosis (LA) and hemorrhage in cerebral amyloid angiopathy (CAA) patients. Methods The earliest MRI images of probable CAA patients and non-CAA patients were collected. The characteristics of LA in the two groups were analyzed. Cerebral micro bleeding (CMB), superficial siderosis (SS), and intracranial hemorrhage (ICH) were recorded in the follow-up study. The space relationship between CMB or SS and ICH was assessed. Results We found that 10/21 (47.6%) patients had occipital prominent LA and 14/21 (66.7%) patients had subcortical punctate LA before the ICH, which was higher than that of the ones in the control group (p = 0.015 and 0.038, respectively). The recurrence rate of ICH was 100% (3/3) in patients with diffuse SS and 36.4% (4/11) in patients without. The recurrence rate of ICH was 60% (3/5) in patients with multiple-lobe CMBs and 44.4% (4/9) in those without. The location of the ICH and CMB was inconsistent. ICH occurred in the ipsilateral cerebral hemisphere of SS in three patients with diffuse SS. Conclusion LA, diffuse SS, and multiple-lobe CMBs are important imaging characteristics of CAA, which may help make early diagnosis and predict the recurrence of ICH.

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Cerebral Amyloid Angiopathy—Related Inflammation: A Single-Center Experience and a Literature Review

Theodorou

Palaiodimou

Safouris

et al. 2022

JCM

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Background: Limited data exist regarding the prevalence of clinical, neuroimaging, and genetic markers among patients diagnosed with Cerebral Amyloid Angiopathy–related inflammation (CAA-ri). We sought to determine these characteristics in patients diagnosed in our center and to summarize available literature published either as single-case reports or small case series (<5 patients). Methods: We reported our single-center experience of patients diagnosed with CAA-ri according to international criteria during a seven-year period (2015–2022), and we abstracted data from 90 previously published cases. Results: Seven patients (43% women, mean age 70 ± 13 years) were diagnosed with CAA-ri in our center. The most common symptom at presentation was focal neurological dysfunction (71%), and the most prevalent radiological finding was the presence of T2/FLAIR white matter hyperintensities (100%). All patients were treated with corticosteroids and had a favorable functional outcome. Among 90 previously published CAA-ri cases (51% women, mean age 70 ± 9 years), focal neurological dysfunction was the most common symptom (76%), followed by a cognitive decline (46%) and headache (34%). The most prevalent neuroimaging findings were cerebral microbleeds (85%), asymmetric T2/FLAIR white matter hyperintensities (81%), and gadolinium-enhancing T1-lesions (37%). Genetic testing for the Apolipoprotein-E gene was available in 27 cases; 59% carried the APOE ε4/ε4 genotype. The majority of the published CAA-ri cases (78%) received corticosteroid monotherapy, while 17 patients (19%) were treated with additional immunosuppressive treatment. Favorable functional outcome following treatment was documented in 70% of patients. Conclusion: Improving the vigilance of clinicians regarding the early recognition and accurate diagnosis of CAA-ri is crucial for swift therapy initiation, which may result in improved functional outcomes.

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Teaching NeuroImages: Acute convexity subarachnoid hemorrhage

Cited by 3 publications

References 2 publications

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of spontaneous subarachnoid haemorrhage

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of spontaneous subarachnoid haemorrhage

Early MRI imaging and follow-up study in cerebral amyloid angiopathy

Cerebral Amyloid Angiopathy—Related Inflammation: A Single-Center Experience and a Literature Review

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