Makoto Nakajima1, Yuichiro Inatomi2, Toshiro Yonehara2, Teruyuki Hirano3, Yukio Ando4. 1. Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan. Electronic address: nakazima@fc.kuh.kumamoto-u.ac.jp. 2. Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan. 3. Department of Neurology and Neuromuscular Disorder, Oita University Faculty of Medicine, Yufu, Japan. 4. Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Abstract
BACKGROUND: Nontraumatic convexal subarachnoid hemorrhage (cSAH) rarely occurs subsequent to acute ischemic stroke. The incidence, clinical background characteristics, and outcomes in acute ischemic stroke patients with cSAH were investigated. METHODS: Our stroke center database was reviewed to identify patients with acute ischemic stroke/transient ischemic attack (TIA) who demonstrated acute cSAH within 14 days of admission between 2005 and 2011. Background characteristics, clinical course, and outcomes at discharge and 3 months after onset were investigated in these patients. RESULTS: Of 4953 acute stroke/TIA patients, cSAH was observed in 8 (.14%) patients (7 men, mean age 71 years): 7 were detected incidentally, and the other was found immediately after a convulsion. Two patients died during their hospital stay, 1 died after discharge, and 3 were dependent at 3 months. Major artery occlusion or severe stenosis was observed in 5 patients. Two patients subsequently developed subcortical hemorrhage. On gradient echo imaging, lobar cerebral microbleeds were observed in 2 patients, and chronic superficial siderosis was observed in 2 patients. CONCLUSIONS: In this retrospective review of cases with ischemic stroke and cSAH, over half of patients had occlusion of major arteries. Cerebral amyloid angiopathy was suggested by magnetic resonance imaging findings and subsequent events in 3 patients. The overall outcome was unfavorable although the causal relationship with cSAH was unclear.
BACKGROUND:Nontraumatic convexal subarachnoid hemorrhage (cSAH) rarely occurs subsequent to acute ischemic stroke. The incidence, clinical background characteristics, and outcomes in acute ischemic strokepatients with cSAH were investigated. METHODS: Our stroke center database was reviewed to identify patients with acute ischemic stroke/transient ischemic attack (TIA) who demonstrated acute cSAH within 14 days of admission between 2005 and 2011. Background characteristics, clinical course, and outcomes at discharge and 3 months after onset were investigated in these patients. RESULTS: Of 4953 acute stroke/TIApatients, cSAH was observed in 8 (.14%) patients (7 men, mean age 71 years): 7 were detected incidentally, and the other was found immediately after a convulsion. Two patients died during their hospital stay, 1 died after discharge, and 3 were dependent at 3 months. Major artery occlusion or severe stenosis was observed in 5 patients. Two patients subsequently developed subcortical hemorrhage. On gradient echo imaging, lobar cerebral microbleeds were observed in 2 patients, and chronic superficial siderosis was observed in 2 patients. CONCLUSIONS: In this retrospective review of cases with ischemic stroke and cSAH, over half of patients had occlusion of major arteries. Cerebral amyloid angiopathy was suggested by magnetic resonance imaging findings and subsequent events in 3 patients. The overall outcome was unfavorable although the causal relationship with cSAH was unclear.
Authors: Min Hyung Lee; Sang Uk Kim; Dong Hoon Lee; Young Il Kim; Chul Bum Cho; Seung Ho Yang; Il Sup Kim; Jae Taek Hong; Jae Hoon Sung; Sang Won Lee Journal: J Cerebrovasc Endovasc Neurosurg Date: 2016-09-30