Convexity subarachnoid haemorrhage has a high risk of intracerebral haemorrhage in suspected cerebral amyloid angiopathy.
The risk of future symptomatic intracerebral haemorrhage (sICH) remains uncertain in patients with acute convexity subarachnoid haemorrhage (cSAH) associated with suspected cerebral amyloid angiopathy (CAA). We assessed the risk of future sICH in patients presenting to our comprehensive stroke service with acute non-traumatic cSAH due to suspected CAA, between 2011 and 2016. We conducted a systematic search and pooled analysis including our cohort and other published studies including similar cohorts. Our hospital cohort included 20 patients (mean age 69 years; 60% male); 12 (60%) had probable CAA, and 6 (30%) had possible CAA according to the modified Boston criteria; two did not meet CAA criteria because of age <55 years, but were judged likely to be due to CAA. Fourteen patients (70%) had cortical superficial siderosis; 12 (60%) had cerebral microbleeds. Over a mean follow-up period of 19 months, 2 patients (9%) suffered sICH, both with probable CAA (annual sICH risk for probable CAA 8%). In a pooled analysis including our cohort and eight other studies (n = 172), the overall sICH rate per patient-year was 16% (95% CI 11-24%). In those with probable CAA (n = 104), the sICH rate per patient-year was 19% (95% CI 13-27%), compared to 7% (95% CI 3-15%) for those without probable CAA (n = 72). Patients with acute cSAH associated with suspected CAA are at high risk of future sICH (16% per patient-year); probable CAA might carry the highest risk.
Stroke Research Centre, UCL Institute of Neurology, University College London, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
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Wilson
Stroke Research Centre, UCL Institute of Neurology, University College London, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
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IC
Hostettler
Department of Statistical Science, UCL, London, WC1E 6BT, UK.
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Ambler
Stroke Research Centre, UCL Institute of Neurology, University College London, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
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Banerjee
Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.
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HR
Jäger
Stroke Research Centre, UCL Institute of Neurology, University College London, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK. d.werring@ucl.ac.uk.
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Werring
D000368:Aged; D000369:Aged, 80 and over; D016657:Cerebral Amyloid Angiopathy / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D012806:Siderosis / Q000453:epidemiology; D015898:Tomography Scanners, X-Ray Computed
Cerebral amyloid angiopathy; Intracerebral haemorrhage; Non-traumatic convexity/convexial/cortical subarachnoid haemorrhage; Stroke; Superficial siderosis