title: Nontraumatic convexal subarachnoid hemorrhage concomitant with acute ischemic stroke.
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.
authors.affiliation: Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan. Electronic address: nakazima@fc.kuh.kumamoto-u.ac.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakajima
authors.affiliation: Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Inatomi
authors.affiliation: Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Yonehara
authors.affiliation: Department of Neurology and Neuromuscular Disorder, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Hirano
authors.affiliation: Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ando
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*; D013345:Subarachnoid Hemorrhage / Q000150:complications*
keywords: Carotid stenosis; cerebral amyloid angiopathy; convexal subarachnoid hemorrhage; intracranial stenosis; superficial siderosis