title: Spontaneous convexity subarachnoid haemorrhage: Clinical series of 3 patients with associated cerebral amyloid angiopathy.
abstract: BACKGROUND
  Convexity subarachnoid haemorrhage (cSAH) is a rare type of spontaneous, non-traumatic, and nonaneurysmal SAH characterised by blood collections in one or more cortical sulci in the convexity of the brain; the aetiology varies. We report a clinical case series of 3 patients with cSAH associated with probable cerebral amyloid angiopathy (CAA) who presented with focal sensory seizures and responded well to corticosteroid treatment.
  
  
  METHODS
  Case 1 was a 67-year-old man reporting right-sided paroxysmal sensory episodes with Jacksonian progression, cheiro-oral symptoms, and motor dysphasia. Case 2 was a 79-year-old man reporting left-sided paroxysmal episodes with cheiro-oral signs and dysarthria. Case 3 was a 71-year-old woman also reporting recurrent left cheiro-oral signs and dysarthria. None of the patients had headache or clinical dementia. Aneurysms were ruled out using MR angiography.
  
  
  RESULTS
  Brain CT scan detected an isolated hyperintensity in a sulcus of the frontal convexity; brain gradient echo T2-weighted MRI sequences showed meningeal haemosiderosis and microbleeds. However, no atrophy was identified in medial temporal lobes including the hippocampal formation. All patients had low levels of beta-amyloid in CSF, low values on the Hulstaert index and high levels of phosphorylated tau protein. Patients were initially treated with prednisone and levetiracetam, but symptoms recurred in 2 patients after prednisone was discontinued.
  
  
  CONCLUSIONS
  We present a series of 3 patients with cSAH associated with CAA, characterised by a stereotypical syndrome responding well to corticoid treatment; there were no cases of headache or clinical dementia.
authors.affiliation: Unidad de Neurología, Hospital Comarcal de Monforte de Lemos, Monforte de Lemos, Lugo, España. Electronic address: daniel.apolinar.garcia.estevez@sergas.es.
authors.forename: D A
authors.initials: DA
authors.lastname: García Estévez
authors.affiliation: Servicio de Radiología, Hospital Comarcal de Monforte de Lemos, Monforte de Lemos, Lugo, España.
authors.forename: R M
authors.initials: RM
authors.lastname: García-Dorrego
authors.affiliation: Servicio de Radiología, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España.
authors.forename: B
authors.initials: B
authors.lastname: Nieto-Baltar
authors.affiliation: Servicio de Radiología, Hospital Comarcal de Monforte de Lemos, Monforte de Lemos, Lugo, España.
authors.forename: M
authors.initials: M
authors.lastname: Marey-Garrido
authors.affiliation: Servicio de Radiología, Hospital Comarcal de Monforte de Lemos, Monforte de Lemos, Lugo, España.
authors.forename: T
authors.initials: T
authors.lastname: Hierro-Torner
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain; D016657:Cerebral Amyloid Angiopathy / Q000150:complications* / Q000473:pathology*; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006486:Hemosiderosis; D006801:Humans; D000077287:Levetiracetam; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000927:Anticonvulsants; D005938:Glucocorticoids; D000077287:Levetiracetam; D003907:Dexamethasone; D011241:Prednisone; D010889:Piracetam
keywords: Apolipoprotein E; Apolipoproteína E; Beta-amyloid peptide; Cheiro-oral symptoms; Hemorragia subaracnoidea; Hemosiderosis meníngea; Meningeal haemosiderosis; Microbleeds; Microsangrados; Péptido beta-amiloide; Subarachnoid haemorrhage; Síntomas queiroorales