Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: an ARIA before the tsunami
Por:
Martinez-Lizana, E, Carmona-Iragui, M, Alcolea, D, Gomez-Choco, M, Vilaplana, E, Sanchez-Saudinos, MB, Clarimon, J, Hernandez-Guillamon, M, Munuera, J, Gelpi, E, Gomez-Anson, B, de Juan-Delago, M, Delgado-Mederos, R, Montaner, J, Ois, A, Amaro, S, Blesa, R, Marti-Fabregas, J, Lleo, A, Fortea, J
Publicada:
1 may 2015
Resumen:
Atraumatic convexal subarachnoid hemorrhage (cSAH) in elderly patients is a rare entity that has been associated with cerebral amyloid angiopathy (CAA) and intracerebral hematomas (ICH). To characterize this entity and to study these associations, 22 patients over 60 with cSAH were included in a multicenter ambispective cohort study. Clinical data, magnetic resonance imaging (MRI) studies, APOE genotyping, and cerebrospinal fluid (CSF) biomarkers were evaluated. Results were compared with data from healthy controls (HC), non-cSAH CAA patients (CAAo), and Alzheimer disease patients. Convexal subarachnoid hemorrhage presented with transient sensory or motor symptoms. At follow-up (median 30.7 months), 5 patients had died, 6 survivors showed functional disability (modified Rankins Scale (mRS)>2), and 12 cognitive impairment. Four patients had prior ICH and six had an ICH during follow-up. CSF-A beta 40 and A beta 42 levels were lower in cSAH and CAAo compared with HC. Convexal subarachnoid hemorrhage presented an APOE-epsilon 2 overrepresentation and CAAo had an APOE-epsilon 4 overrepresentation. On MRI, all patients fulfilled CAA-modified Boston criteria and 9 showed cortical ischemia in the surrounding cortex or the vicinity of superficial siderosis. The neuropathologic study, available in one patient, showed severe CAA and advanced Alzheimer-type pathology. Convexal subarachnoid hemorrhage in the elderly is associated with cognitive impairment and lobar ICH occurrence. Our findings support the existence of an underlying CAA pathology.
Filiaciones:
Martinez-Lizana, E:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Memory Unit,Dept Neurol, E-08193 Barcelona, Spain
CIBERNED, Madrid, Spain
Carmona-Iragui, M:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Memory Unit,Dept Neurol, E-08193 Barcelona, Spain
CIBERNED, Madrid, Spain
Alcolea, D:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Memory Unit,Dept Neurol, E-08193 Barcelona, Spain
CIBERNED, Madrid, Spain
Gomez-Choco, M:
Hosp St Joan Desp Moises Broggi, Dept Neurol, Barcelona, Spain
Vilaplana, E:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Memory Unit,Dept Neurol, E-08193 Barcelona, Spain
CIBERNED, Madrid, Spain
Sanchez-Saudinos, MB:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Memory Unit,Dept Neurol, E-08193 Barcelona, Spain
CIBERNED, Madrid, Spain
Clarimon, J:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Memory Unit,Dept Neurol, E-08193 Barcelona, Spain
CIBERNED, Madrid, Spain
Hernandez-Guillamon, M:
Univ Autonoma Barcelona, Vall dHebron Res Insitute, Hosp Vall dHebron, Dept Neurol, E-08193 Barcelona, Spain
Munuera, J:
Hosp Badalona Germans Trias & Pujol, MRI Unit Badalona, Inst Diagnost Imatge, Barcelona, Spain
Gelpi, E:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Hosp Clin, Neurol Tissue Bank Biobanc, Barcelona, Spain
Gomez-Anson, B:
Hosp Santa Creu & Sant Pau, Dept Radiol, Neuroradiol Unit, Barcelona, Spain
de Juan-Delago, M:
Hosp Santa Creu & Sant Pau, Dept Radiol, Neuroradiol Unit, Barcelona, Spain
Delgado-Mederos, R:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Stroke Unit,Dept Neurol, E-08193 Barcelona, Spain
Montaner, J:
Univ Autonoma Barcelona, Vall dHebron Res Insitute, Hosp Vall dHebron, Dept Neurol, E-08193 Barcelona, Spain
Ois, A:
Hosp del Mar, Dept Neurol, Barcelona, Spain
Amaro, S:
Hosp Clin Barcelona, Dept Neurol, Barcelona, Spain
Blesa, R:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Memory Unit,Dept Neurol, E-08193 Barcelona, Spain
CIBERNED, Madrid, Spain
Marti-Fabregas, J:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Stroke Unit,Dept Neurol, E-08193 Barcelona, Spain
Lleo, A:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Memory Unit,Dept Neurol, E-08193 Barcelona, Spain
CIBERNED, Madrid, Spain
Fortea, J:
Univ Autonoma Barcelona, Biomed Res Inst St Pau, Hosp Santa Creu & St Pau, Memory Unit,Dept Neurol, E-08193 Barcelona, Spain
CIBERNED, Madrid, Spain
Green Published, Bronze
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