title: Contribution of convexal subarachnoid hemorrhage to disease progression in cerebral amyloid angiopathy.
abstract: OBJECTIVE
  Cerebral amyloid angiopathy-related cortical superficial siderosis (cSS) seems to indicate an increased risk of subsequent intracerebral hemorrhage (ICH). We wanted to identify the mechanisms and sequence of hemorrhagic events which are responsible for this association.
  
  
  METHODS
  During a 9-year-period, we identified patients with spontaneous convexal subarachnoid hemorrhage (cSAH) and performed a careful longitudinal analysis of clinical and neuroimaging data. A close imaging-histopathologic correlation was performed in one patient.
  
  
  RESULTS
  Of 38 cSAH patients (mean age, 77±11 years), 29 (76%) had imaging features of cerebral amyloid angiopathy on baseline magnetic resonance imaging. Twenty-six (68%) had cSS. Sixteen subjects underwent postcontrast magnetic resonance imaging. Extravasation of gadolinium at the site of the acute cSAH was seen on all postcontrast scans. After a mean of 24±22 (range 1-78) months of follow-up, 15 (39%) had experienced recurrent cSAHs and 14 (37%) had suffered lobar ICHs. Of 22 new ICHs, 17 occurred at sites of previous cSAHs or cSS. Repeated neuroimaging showed expansion of cSAH into the brain parenchyma and evolution of a lobar ICH in 4 patients. Propagation of cSS was observed in 21 (55%) patients, with 14 of those having experienced recurrent cSAHs. In the autopsy case, leakage of meningeal vessels affected by cerebral amyloid angiopathy was noted.
  
  
  CONCLUSIONS
  In cerebral amyloid angiopathy, leakage of meningeal vessels seems to be a major cause for recurrent intrasulcal bleedings, which lead to the propagation of cSS and indicate sites with increased vulnerability for future ICH. Intracerebral bleedings may also develop directly from or in extension of a cSAH.
authors.affiliation: From the Department of Neurology, Medical University of Graz, Graz, Austria (M.B., C.E., T.G., F.F.); Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria (C.E.); Department of Pathology, Medical University of Graz, Graz, Austria (M.A.); and Department for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria (G.W.). markus.beitzke@klinikum-graz.at.
authors.forename: Markus
authors.initials: M
authors.lastname: Beitzke
authors.affiliation: From the Department of Neurology, Medical University of Graz, Graz, Austria (M.B., C.E., T.G., F.F.); Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria (C.E.); Department of Pathology, Medical University of Graz, Graz, Austria (M.A.); and Department for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria (G.W.).
authors.forename: Christian
authors.initials: C
authors.lastname: Enzinger
authors.affiliation: From the Department of Neurology, Medical University of Graz, Graz, Austria (M.B., C.E., T.G., F.F.); Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria (C.E.); Department of Pathology, Medical University of Graz, Graz, Austria (M.A.); and Department for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria (G.W.).
authors.forename: Gerit
authors.initials: G
authors.lastname: Wünsch
authors.affiliation: From the Department of Neurology, Medical University of Graz, Graz, Austria (M.B., C.E., T.G., F.F.); Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria (C.E.); Department of Pathology, Medical University of Graz, Graz, Austria (M.A.); and Department for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria (G.W.).
authors.forename: Martin
authors.initials: M
authors.lastname: Asslaber
authors.affiliation: From the Department of Neurology, Medical University of Graz, Graz, Austria (M.B., C.E., T.G., F.F.); Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria (C.E.); Department of Pathology, Medical University of Graz, Graz, Austria (M.A.); and Department for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria (G.W.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Gattringer
authors.affiliation: From the Department of Neurology, Medical University of Graz, Graz, Austria (M.B., C.E., T.G., F.F.); Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria (C.E.); Department of Pathology, Medical University of Graz, Graz, Austria (M.A.); and Department for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria (G.W.).
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016657:Cerebral Amyloid Angiopathy / Q000150:complications* / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008578:Meninges / Q000098:blood supply / Q000000981:diagnostic imaging; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: cerebral amyloid angiopathy; intracerebral hemorrhage; subarachnoid hemorrhage