Nicolas Raposo1, Andreas Charidimou2, Duangnapa Roongpiboonsopit2, Michelle Onyekaba2, M Edip Gurol2, Jonathan Rosand2, Steven M Greenberg2, Joshua N Goldstein2, Anand Viswanathan2. 1. From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand. raposo.n@chu-toulouse.fr. 2. From the Stroke Research Center (N.R., A.C., D.R., M.O., M.E.G., J.R., S.M.G., J.N.G., A.V.), Department of Neurology, Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.), Center for Genomic Medicine (J.R.), and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Division of Neurology (D.R.), Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand.
Abstract
OBJECTIVE: To investigate whether acute convexity subarachnoid hemorrhage (cSAH) associated with acute lobar intracerebral hemorrhage (ICH) increases the risk of ICH recurrence in patients with cerebral amyloid angiopathy (CAA). METHODS: We analyzed data from a prospective cohort of consecutive survivors of acute spontaneous lobar ICH fulfilling the Boston criteria for possible or probable CAA (CAA-ICH). We analyzed baseline clinical and MRI data, including cSAH (categorized as adjacent or remote from ICH on a standardized scale), cortical superficial siderosis (cSS), and other CAA MRI markers. Multivariable Cox regression models were used to assess the association between cSAH and recurrent symptomatic ICH during follow-up. RESULTS: We included 261 CAA-ICH survivors (mean age 76.2 ± 8.7 years). Of them, 166 (63.6%, 95% confidence interval [CI] 57.7%-69.5%) had cSAH on baseline MRI. During a median follow-up of 28.3 (interquartile range 7.2-57.0) months, 54 (20.7%) patients experienced a recurrent lobar ICH. In Cox regression, any cSAH, adjacent cSAH, and remote cSAH were independent predictors of recurrent ICH after adjustment for other confounders, including cSS. Incidence rate of recurrent ICH in patients with cSAH was 9.9 per 100 person-years (95% CI 7.3-13.0) compared with 1.2 per 100 person-years (95% CI 0.3-3.2) in those without cSAH (adjusted hazard ratio 7.5, 95% CI 2.6-21.1). CONCLUSION: In patients with CAA-related acute ICH, cSAH (adjacent or remote from lobar ICH) is commonly observed and heralds an increased risk of recurrent ICH. cSAH may help stratify bleeding risk and should be assessed along with cSS for prognosis and clinical management.
OBJECTIVE: To investigate whether acute convexity subarachnoid hemorrhage (cSAH) associated with acute lobar intracerebral hemorrhage (ICH) increases the risk of ICH recurrence in patients with cerebral amyloid angiopathy (CAA). METHODS: We analyzed data from a prospective cohort of consecutive survivors of acute spontaneous lobar ICH fulfilling the Boston criteria for possible or probable CAA (CAA-ICH). We analyzed baseline clinical and MRI data, including cSAH (categorized as adjacent or remote from ICH on a standardized scale), cortical superficial siderosis (cSS), and other CAA MRI markers. Multivariable Cox regression models were used to assess the association between cSAH and recurrent symptomatic ICH during follow-up. RESULTS: We included 261 CAA-ICH survivors (mean age 76.2 ± 8.7 years). Of them, 166 (63.6%, 95% confidence interval [CI] 57.7%-69.5%) had cSAH on baseline MRI. During a median follow-up of 28.3 (interquartile range 7.2-57.0) months, 54 (20.7%) patients experienced a recurrent lobar ICH. In Cox regression, any cSAH, adjacent cSAH, and remote cSAH were independent predictors of recurrent ICH after adjustment for other confounders, including cSS. Incidence rate of recurrent ICH in patients with cSAH was 9.9 per 100 person-years (95% CI 7.3-13.0) compared with 1.2 per 100 person-years (95% CI 0.3-3.2) in those without cSAH (adjusted hazard ratio 7.5, 95% CI 2.6-21.1). CONCLUSION: In patients with CAA-related acute ICH, cSAH (adjacent or remote from lobar ICH) is commonly observed and heralds an increased risk of recurrent ICH. cSAH may help stratify bleeding risk and should be assessed along with cSS for prognosis and clinical management.
Authors: H C O'Donnell; J Rosand; K A Knudsen; K L Furie; A Z Segal; R I Chiu; D Ikeda; S M Greenberg Journal: N Engl J Med Date: 2000-01-27 Impact factor: 91.245
Authors: Craig S Anderson; Emma Heeley; Yining Huang; Jiguang Wang; Christian Stapf; Candice Delcourt; Richard Lindley; Thompson Robinson; Pablo Lavados; Bruce Neal; Jun Hata; Hisatomi Arima; Mark Parsons; Yuechun Li; Jinchao Wang; Stephane Heritier; Qiang Li; Mark Woodward; R John Simes; Stephen M Davis; John Chalmers Journal: N Engl J Med Date: 2013-05-29 Impact factor: 91.245
Authors: Andreas Charidimou; Grégoire Boulouis; Panagiotis Fotiadis; Li Xiong; Alison M Ayres; Kristin M Schwab; Mahmut Edip Gurol; Jonathan Rosand; Steve M Greenberg; Anand Viswanathan Journal: J Neurol Neurosurg Psychiatry Date: 2017-10-20 Impact factor: 13.654
Authors: Andreas Charidimou; Gregoire Boulouis; Duangnapa Roongpiboonsopit; Eitan Auriel; Marco Pasi; Kellen Haley; Ellis S van Etten; Sergi Martinez-Ramirez; Alison Ayres; Anastasia Vashkevich; Kristin M Schwab; Joshua N Goldstein; Jonathan Rosand; Anand Viswanathan; Steven M Greenberg; M Edip Gurol Journal: Neurology Date: 2017-10-25 Impact factor: 11.800
Authors: Mark A Rodrigues; Neshika Samarasekera; Christine Lerpiniere; Catherine Humphreys; Mark O McCarron; Philip M White; James A R Nicoll; Cathie L M Sudlow; Charlotte Cordonnier; Joanna M Wardlaw; Colin Smith; Rustam Al-Shahi Salman Journal: Lancet Neurol Date: 2018-01-10 Impact factor: 44.182
Authors: Qi Li; Maria Clara Zanon Zotin; Andrew D Warren; Yuan Ma; Edip Gurol; Joshua N Goldstein; Steven M Greenberg; Andreas Charidimou; Nicolas Raposo; Anand Viswanathan Journal: Neurology Date: 2020-10-21 Impact factor: 9.910