Solène Moulin1, Barbara Casolla1, Grégory Kuchcinski1, Gregoire Boulouis1, Costanza Rossi1, Hilde Hénon1, Didier Leys1, Charlotte Cordonnier2. 1. From Université de Lille (S.M., B.C., G.K., C.R., H.H., D.L., C.C.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille; and Departments of Neurology (S.M., B.C., C.R., H.H., D.L., C.C.), Neuroradiology (G.K.), and Neuroradiology (G.B.), Centre Hospitalier Saint-Anne, Université Paris-Descartes, Inserm U894, France. 2. From Université de Lille (S.M., B.C., G.K., C.R., H.H., D.L., C.C.), Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille; and Departments of Neurology (S.M., B.C., C.R., H.H., D.L., C.C.), Neuroradiology (G.K.), and Neuroradiology (G.B.), Centre Hospitalier Saint-Anne, Université Paris-Descartes, Inserm U894, France. charlotte.cordonnier@univ-lille2.fr.
Abstract
OBJECTIVE: To determine the prevalence of cortical superficial siderosis (cSS), its clinical and neuroimaging associated markers, and its influence on the risk of recurrent intracerebral hemorrhage (ICH) in a prospective observational ICH cohort. METHODS: We investigated clinical and radiologic markers associated with cSS using multivariable analysis. In survival analyses, we used Cox models to identify predictors of recurrent ICH after adjusting for potential confounders. RESULTS: Of the 258 patients included in the study, 49 (19%; 95% confidence interval [CI] 14%-24%) had cSS at baseline. Clinical factors independently associated with the presence of cSS were increasing age (odds ratio [OR] 1.03 per 1-year increase, 95% CI 1.001-1.06, p = 0.044), preexisting dementia (OR 2.62, 95% CI 1.05-6.51, p = 0.039), and history of ICH (OR 4.02, 95% CI 1.24-12.95, p = 0.02). Among radiologic biomarkers, factors independently associated with the presence of cSS were ICH lobar location (OR 24.841, 95% CI 3.2-14.47, p < 0.001), severe white matter hyperintensities score (OR 5.51, 95% CI 1.17-5.78, p = 0.019), and absence of lacune (OR 4.46, 95% CI 1.06-5.22, p = 0.035). During a median follow-up of 6.4 (interquartile range 2.9-8.4) years, recurrent ICH occurred in 19 patients. Only disseminated cSS (hazard ratio 4.69, 95% CI 1.49-14.71, p = 0.008), not the presence or absence of cSS or focal cSS on baseline MRI, was associated with recurrent symptomatic ICH. CONCLUSION: In a prospective observational cohort of spontaneous ICH, clinical and radiologic markers associated with cSS suggest the implication of underlying cerebral amyloid angiopathy. Disseminated cSS may become a key prognostic neuroimaging marker of recurrent ICH that could be monitored in future clinical trials dedicated to patients with ICH.
OBJECTIVE: To determine the prevalence of cortical superficial siderosis (cSS), its clinical and neuroimaging associated markers, and its influence on the risk of recurrent intracerebral hemorrhage (ICH) in a prospective observational ICH cohort. METHODS: We investigated clinical and radiologic markers associated with cSS using multivariable analysis. In survival analyses, we used Cox models to identify predictors of recurrent ICH after adjusting for potential confounders. RESULTS: Of the 258 patients included in the study, 49 (19%; 95% confidence interval [CI] 14%-24%) had cSS at baseline. Clinical factors independently associated with the presence of cSS were increasing age (odds ratio [OR] 1.03 per 1-year increase, 95% CI 1.001-1.06, p = 0.044), preexisting dementia (OR 2.62, 95% CI 1.05-6.51, p = 0.039), and history of ICH (OR 4.02, 95% CI 1.24-12.95, p = 0.02). Among radiologic biomarkers, factors independently associated with the presence of cSS were ICH lobar location (OR 24.841, 95% CI 3.2-14.47, p < 0.001), severe white matter hyperintensities score (OR 5.51, 95% CI 1.17-5.78, p = 0.019), and absence of lacune (OR 4.46, 95% CI 1.06-5.22, p = 0.035). During a median follow-up of 6.4 (interquartile range 2.9-8.4) years, recurrent ICH occurred in 19 patients. Only disseminated cSS (hazard ratio 4.69, 95% CI 1.49-14.71, p = 0.008), not the presence or absence of cSS or focal cSS on baseline MRI, was associated with recurrent symptomatic ICH. CONCLUSION: In a prospective observational cohort of spontaneous ICH, clinical and radiologic markers associated with cSS suggest the implication of underlying cerebral amyloid angiopathy. Disseminated cSS may become a key prognostic neuroimaging marker of recurrent ICH that could be monitored in future clinical trials dedicated to patients with ICH.
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