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.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hemorrhagic manifestations of reversible cerebral vasoconstriction syndrome: frequency, features, and risk factors.Stroke. 2010; 41: 2505-2511
- Isolated acute nontraumatic cortical subarachnoid hemorrhage.AJNR Am J Neuroradiol. 2010; 31: 1355-1362
- Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies.Neurology. 2010; 74: 893-899
- Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy.Neurology. 2010; 74: 1346-1350
- Cortical subarachnoid haemorrhage in the elderly: a recurrent event probably related to cerebral amyloid angiopathy.Eur J Neurol. 2011; 18: 597-603
- Atraumatic localized convexity subarachnoid hemorrhage associated with acute carotid artery occlusion.Eur J Neurol. 2011; 18: e28-e29
- Extracranial internal carotid artery stenosis as a cause of cortical subarachnoid hemorrhage.AJNR Am J Neuroradiol. 2011; 32 (author reply E53): E51-E52
- Clinical presentation, etiology, and long-term prognosis in patients with nontraumatic convexal subarachnoid hemorrhage.Stroke. 2011; 42: 3055-3060
- Atraumatic nonaneurysmal sulcal subarachnoid hemorrhages: a diagnostic workup based on a case series.Cerebrovasc Dis. 2012; 34: 147-152
- Subarachnoid hemosiderosis and superficial cortical hemosiderosis in cerebral amyloid angiopathy.AJNR Am J Neuroradiol. 2008; 29: 184-186
- Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria.Neurology. 2001; 56: 537-539
- Subarachnoid haemorrhage: diagnosis, causes and management.Brain. 2001; 124: 249-278
- Cerebral beta amyloid angiopathy is a risk factor for cerebral ischemic infarction. A case control study in human brain biopsies.J Neuropathol Exp Neurol. 2000; 59: 768-773
- Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy.Neurology. 2009; 72: 1230-1235
- Cerebrovascular complications in patients with cancer.Semin Neurol. 2010; 30: 311-319
- Intracerebral and subarachnoid hemorrhage in patients with cancer.Neurology. 2010; 74: 494-501
- Incidental unruptured intracranial aneurysms in patients with acute ischemic stroke.Cerebrovasc Dis. 2008; 26: 650-653
Article info
Publication history
Published online: March 17, 2014
Accepted:
December 25,
2013
Received in revised form:
December 23,
2013
Received:
November 26,
2013
Footnotes
Conflicts of interest: None.
Source of funding: None.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.12.046
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
