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

Abstract

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

The Spectrum of MR Detectable Cortical Microinfarcts: A Classification Study with 7-Tesla Postmortem MRI and Histopathology

“…23 Enlarged PVSs are a common finding in the white matter, especially in the context of CAA. 24 In our study, MR identified 'lesions' in juxtacortical areas that had similar appearance as intracortical CMIs proved to be PVSs on histology. When rating CMIs on in vivo MRI, juxtacortical hyperintense lesions should best be discarded.…”

MRI-visible perivascular space location is associated with Alzheimer's disease independently of amyloid burden

“…The association of AD and increased white matter PVS volume has also been demonstrated using neuroimaging (Ramirez et al, 2015). PVS in the centrum semiovale (CSO-PVS) are associated with CAA-related intracerebral haemorrhage (ICH) (Charidimou et al, 2013b;Charidimou et al, 2014b) and its "haemorrhagic" markers, namely lobar microbleeds (Martinez- Ramirez et al, 2013;Yakushiji et al, 2014) and cortical superficial siderosis (Charidimou et al, 2014a). Indeed, a recent study using post-mortem 7-Tesla MR in CAA-related ICH found an association between juxta-cortical PVS enlargement and the histopathological grade of CAA in the overlying cortex (van Veluw et al, 2015).…”

Sporadic cerebral amyloid angiopathy as a cause of relapsing lobar hemorrhage, convexal subarachnoid hemorrhage and cortical superficial siderosis

“…This last feature is indicative of old residual subclinical superficial bleeding, characteristic of CCA. GRE T2W imaging revealed subarachnoid siderosis and cortical superficial siderosis, defined as linear blood residues, in the superficial cortical layers of the brain, due to recurrent bleeding [5].…”

“…Amyloid deposits have been also observed in the capillaries of central nervous system, parenchyma and leptomeninges [2]. CAA mostly occurs in the sporadic form in the elderly, while rare familial forms occur in younger patients and are generally lead to more severe clinical manifestations [3][4][5]. CAA is considered the third most common cause of spontaneous intracerebral hemorrhage after hypertension and subarachnoid aneurysmal hemorrhage [1][2][3].…”

“…Transient focal neurological episodes are recognized in cerebral amyloid angiopathy and may herald a high risk of intracerebral hemorrhage. Another characteristic clinical presentation associated with CAA, is the transient focal neurological episodes, termed ''amyloid spells'' [5]. The spells are typically brief and are characterized by recurrent, stereotyped episodes of 'positive' spreading sensory symptoms (paresthesia).…”