title: Nontraumatic convexity subarachnoid hemorrhage: different etiologies and outcomes.
abstract: BACKGROUND
  Nontraumatic convexity subarachnoid hemorrhage (cSAH) is a rarely reported condition with multiple etiologies. We report the clinical presentation, imaging findings, etiologies, and long-term outcomes of a case series of cSAH.
  
  
  METHODS
  We retrospectively analyzed consecutive cases of cSAH, admitted at a Stroke Unit of a tertiary hospital (January 2006 to March 2012). Recorded variables were demographics, clinical presentation, complementary investigation, etiology, and outcome.
  
  
  RESULTS
  We included 15 patients (9 men, median age of 65 years), 7% of the 210 nontraumatic SAH patients in this period. The most common clinical manifestation was a focal neurologic deficit. Predominant location of the cSAH was frontal. In 5 cases, there was a clinical significant internal carotid artery (ICA) atheromatous stenosis, ipsilateral to cSAH. Two patients had a possible cerebral amyloid angiopathy (CAA) at presentation. There were 2 cases of reversible cerebral vasoconstriction syndrome, 1 cerebral venous thrombosis, 2 dural fistulae, and 3 undetermined. Short-term outcomes were good in most patients. At follow-up (24.3 months), 2 of the patients with undetermined etiology had a lobar hematoma conferring a severe disability, and the diagnosis of CAA was made. There were no other relevant events or added disability in the other patients.
  
  
  CONCLUSIONS
  Significant ICA atherosclerotic stenosis was the most frequent cause of cSAH in our series, reinforcing that cSAH should prompt vascular imagiological evaluation including cervical vessels. Outcomes in cSAH seem to be related to etiology. Patients with undetermined etiology should be followed up because cSAH may be the first manifestation of CAA.
authors.affiliation: Stroke Unit, Department of Neurosciences (Neurology), Hospital de Santa Maria, Lisbon, Portugal. Electronic address: ruth.geraldes@gmail.com.
authors.forename: Ruth
authors.initials: R
authors.lastname: Geraldes
authors.affiliation: Stroke Unit, Department of Neurosciences (Neurology), Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Sousa
authors.affiliation: Stroke Unit, Department of Neurosciences (Neurology), Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Fonseca
authors.affiliation: Stroke Unit, Department of Neurosciences (Neurology), Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Falcão
authors.affiliation: Stroke Unit, Department of Neurosciences (Neurology), Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Canhão
authors.affiliation: Stroke Unit, Department of Neurosciences (Neurology), Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Pinho e Melo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D020521:Stroke / Q000209:etiology / Q000473:pathology; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
keywords: Convexity subarachnoid hemorrhage; acute ischemic stroke; amyloid angiopathy; atherosclerotic carotid artery stenosis or occlusion; cortical subarachnoid haemorrhage; hyperdense sulcus