BACKGROUND AND PURPOSE: The full spectrum of causes of convexal subarachnoid hemorrhage (cSAH) requires further investigation. Therefore, our objective was to describe the spectrum of clinical and imaging features of patients with non-traumatic cSAH. METHODS: A retrospective observational study of consecutive patients with non-traumatic cSAH was performed at a tertiary referral center. The underlying cause of cSAH was characterized and clinical and imaging features that predict a specific etiology were identified. The frequency of future cSAH or intracerebral hemorrhage (ICH) was determined. RESULTS: In all, 88 patients [median age 64 years (range 25-85)] with non-traumatic cSAH were identified. The most common causes were reversible cerebral vasoconstriction syndrome (RCVS) (26, 29.5%), cerebral amyloid angiopathy (CAA) (23, 26.1%), indeterminate (14, 15.9%) and endocarditis (9, 10.2%). CAA patients commonly presented at an older age than RCVS patients (75 years versus 51 years, P < 0.0001). Thirteen patients (14.7%) had recurrent cSAH, and 12 patients (13.6%) had a subsequent ICH. However, the risk was high amongst those with CAA compared to those caused by RCVS, with recurrent cSAH in 39.1% and subsequent lobar ICH in 43.5% of CAA cases. CONCLUSIONS: Our study demonstrates the clinical diversity of cSAH. Older age, sensorimotor dysfunction and stereotyped spells suggest CAA as the underlying cause. Younger age and thunderclap headache predict RCVS. Yet, various other causes also need to be considered in the differential diagnosis.
BACKGROUND AND PURPOSE: The full spectrum of causes of convexal subarachnoid hemorrhage (cSAH) requires further investigation. Therefore, our objective was to describe the spectrum of clinical and imaging features of patients with non-traumaticcSAH. METHODS: A retrospective observational study of consecutive patients with non-traumaticcSAH was performed at a tertiary referral center. The underlying cause of cSAH was characterized and clinical and imaging features that predict a specific etiology were identified. The frequency of future cSAH or intracerebral hemorrhage (ICH) was determined. RESULTS: In all, 88 patients [median age 64 years (range 25-85)] with non-traumaticcSAH were identified. The most common causes were reversible cerebral vasoconstriction syndrome (RCVS) (26, 29.5%), cerebral amyloid angiopathy (CAA) (23, 26.1%), indeterminate (14, 15.9%) and endocarditis (9, 10.2%). CAA patients commonly presented at an older age than RCVS patients (75 years versus 51 years, P < 0.0001). Thirteen patients (14.7%) had recurrent cSAH, and 12 patients (13.6%) had a subsequent ICH. However, the risk was high amongst those with CAA compared to those caused by RCVS, with recurrent cSAH in 39.1% and subsequent lobar ICH in 43.5% of CAA cases. CONCLUSIONS: Our study demonstrates the clinical diversity of cSAH. Older age, sensorimotor dysfunction and stereotyped spells suggest CAA as the underlying cause. Younger age and thunderclap headache predict RCVS. Yet, various other causes also need to be considered in the differential diagnosis.
Authors: Micah Yost; Catherine Arnold Fiebelkorn; Alejandro A Rabinstein; James Klaas; Jeremiah A Aakre; Robert D Brown; Michelle M Mielke; David S Knopman; Val Lowe; Ronald C Petersen; Clifford R Jack; Prashanthi Vemuri; Jonathan Graff-Radford Journal: J Stroke Cerebrovasc Dis Date: 2019-10-24 Impact factor: 2.136
Authors: Isabel Charlotte Hostettler; Duncan Wilson; Catherine Arnold Fiebelkorn; Diane Aum; Sebastián Francisco Ameriso; Federico Eberbach; Markus Beitzke; Timothy Kleinig; Thanh Phan; Sarah Marchina; Romain Schneckenburger; Maria Carmona-Iragui; Andreas Charidimou; Isabelle Mourand; Sara Parreira; Gareth Ambler; Hans Rolf Jäger; Shaloo Singhal; John Ly; Henry Ma; Emmanuel Touzé; Ruth Geraldes; Ana Catarina Fonseca; Teresa Melo; Pierre Labauge; Pierre-Henry Lefèvre; Anand Viswanathan; Steven Mark Greenberg; Juan Fortea; Marion Apoil; Marion Boulanger; Fausto Viader; Sandeep Kumar; Velandai Srikanth; Ashan Khurram; Franz Fazekas; Veronica Bruno; Gregory Joseph Zipfel; Daniel Refai; Alejandro Rabinstein; Jonathan Graff-Radford; David John Werring Journal: J Neurol Date: 2021-07-17 Impact factor: 4.849