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Boukobza M, Ilic-Habensus E, Duval X, Laissy JP. Acute convexity subarachnoid hemorrhage (cSAH) in infectious endocarditis (IE): imaging features and follow-up. J Neurol 2020; 267:2971-2982. [PMID: 32494850 DOI: 10.1007/s00415-020-09953-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
AIM To assess: (1) the prevalence of convexity subarachnoid hemorrhage (cSAH) in infective endocarditis (IE); (2) its relationship with IE features; (3) the associated lesions; (4) whether cSAH is a predictor of future hemorrhage; (5) whether cSAH could cause cortical superficial siderosis (cSS). METHODS We retrospectively evaluated the MRI data in 240 IE-patients: At baseline, the location of cSAH and associated lesions; at follow-up, the occurrence of new lesions and of cSS. Patients with and without cSAH were compared. RESULTS There were 21 cSAH-IE patients without (Group 1a) and 10 with intracranial infectious aneurysms (IIAs) (Group 1b). cSAH was revealed by headache (16.1%), confusion (9.7%), acute meningeal syndrome (3.2%) and was incidental in 71%. In most cases, the cSAH was: in the frontal (61.3%) and the parietal lobe (16.1%), unifocal, and mainly localized within a single sulcus (80.7%), appearing as a thick intrasulcal dark line on T2* in 70% of IIA patients. Valvular vegetations (87.1%, p < 0.0001), vegetations length ≥ 15 mm (58.1%, p < 0.0001) and mitral valve involvement (61.3%; p = 0.05) were significantly associated. There was no significant difference between the two groups in terms of pathogen distribution, valve characteristics and clinical expression. Associated lesions were: CMBs (77.4%), DWILs (51.6%), brain hemorrhages (16.1%) brain micro-abscesses (3.2%) meningitis (3.2%), visceral emboli (45.2%). At follow-up: no SAH recurrence or neurological event. cSS disappeared in 7/12 cases. CONCLUSION cSAH in IE is mostly an incidental finding but may be the telltale sign of an IIA. cSAH is not a marker of poor prognosis in non-IIA patients.
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Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Emila Ilic-Habensus
- Center of Clinical Investigations, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Xavier Duval
- Center of Clinical Investigations, Inserm 1425, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris-Diderot University, Inserm U1137, Paris, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris-Diderot University, Inserm U1148, Paris, France
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Lee MH, Kim SU, Lee DH, Kim YI, Cho CB, Yang SH, Kim IS, Hong JT, Sung JH, Lee SW. Evaluation and Treatment of the Acute Cerebral Infarction with Convexal Subarachnoid Hemorrhage. J Cerebrovasc Endovasc Neurosurg 2016; 18:271-275. [PMID: 27847773 PMCID: PMC5104854 DOI: 10.7461/jcen.2016.18.3.271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 09/01/2016] [Accepted: 09/12/2016] [Indexed: 12/17/2022] Open
Abstract
Non-traumatic convexal subarachnoid hemorrhage (CSAH) is a comparatively infrequent with various vascular and nonvascular causes, it rarely occurs concomitant to acute ischemic stroke. We report a case of a 59-year-old woman, visited emergency room with right side subjective weakness spontaneously. Magnetic resonance diffusion-weighted images revealed an acute infarction of anterior cerebral arterial territory. Computed tomographic angiography showed a left frontal CSAH without any vascular lesions. And other laboratory studies were non-specific. We treated with dual antiplatelet drugs (cilostazole [Otsuka Pharmaceutical Co., Ltd. tokyo, Japan] and Aspirin [Bayer Pharma AG., Leverkusen, Germany]). She has done well for a follow-up period. (5 months) This case demonstrates the CSAH with acute infarction is rare but need to work up to identify the etiology and antiplatelet dugs are taken into account for treatments.
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Affiliation(s)
- Min Hyung Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Sang Uk Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Dong Hoon Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Young Il Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Chul Bum Cho
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seung Ho Yang
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Sang Won Lee
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Abstract
OBJECTIVE Spontaneous subarachnoid hemorrhage (SAH) typically prompts a search for an underlying ruptured saccular aneurysm, which is the most common nontraumatic cause. Depending on the clinical presentation and pattern of SAH, the differential diagnosis may include a diverse group of causes other than aneurysm rupture. CONCLUSION For the purposes of this review, we classify SAH into three main patterns, defined by the distribution of blood on unenhanced CT: diffuse, perimesencephalic, and convexal. The epicenter of the hemorrhage further refines the differential diagnosis and guides subsequent imaging. Additionally, we review multiple clinical conditions that can simulate the appearance of SAH on CT or MRI, an imaging artifact known as pseudo-SAH.
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Cuvinciuc V, Vargas MI, Lovblad KO, Haller S. Diagnosing infection of the CNS with MRI. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.11.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cuvinciuc V, Viguier A, Calviere L, Raposo N, Larrue V, Cognard C, Bonneville F. Isolated acute nontraumatic cortical subarachnoid hemorrhage. AJNR Am J Neuroradiol 2010; 31:1355-62. [PMID: 20093311 DOI: 10.3174/ajnr.a1986] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Our aim was to review the etiologic background of isolated acute nontraumatic cSAH. While SAH located in the basal cisterns originates from a ruptured aneurysm in approximately 85% of cases, a broad spectrum of vascular and even nonvascular pathologies can cause acute nontraumatic SAH along the convexity. Arteriovenous malformations or fistulas, cortical venous and/or dural sinus thrombosis, and distal and proximal arteriopathies (RCVS, vasculitides, mycotic aneurysms, Moyamoya, or severe atherosclerotic carotid disease) should be sought by noninvasive imaging methods or/and conventional angiography. Additionally, PRES may also be a source of acute cSAH. In elderly patients, cSAH might be attributed to CAA if numerous hemorrhages are demonstrated by GRE T2 images. Finally, cSAH is rarely observed in nonvascular disorders, such as abscess and primitive or secondary brain tumors.
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Affiliation(s)
- V Cuvinciuc
- Department of Neuroradiology, University Hospital, Toulouse, France
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Refai D, Botros JA, Strom RG, Derdeyn CP, Sharma A, Zipfel GJ. Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course. J Neurosurg 2008; 109:1034-41. [DOI: 10.3171/jns.2008.109.12.1034] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Object
The clinical characteristics and overall outcome in patients with spontaneous isolated convexity subarachnoid hemorrhage (SAH) are not well described in the literature. The purpose of this study was to examine the mode of presentation, common origins, radiographic findings, and clinical course in a large case series of such patients.
Methods
A retrospective single-center chart review of all patients in whom nontraumatic primary convexity SAH was diagnosed between 2002 and 2007 was performed. Twenty patients were identified and analyzed for presenting symptoms, radiological and laboratory findings, hospital course, and outcome.
Results
There were 15 women and 5 men in our series, and the mean age was 52 years (range 18–86 years). The most common presenting symptom was headache, with 15 patients experiencing it as a chief complaint. Other frequent manifestations included altered mental status (8 patients), focal neurological deficits (7), and seizure (4 patients). An underlying cause of the hemorrhage was identified in 13 cases, whereas the remainder went unresolved. Of the known causes, 5 were due to posterior reversible encephalopathy syndrome, 3 were caused by thrombocytopenia or anticoagulation, and the remainder were isolated cases of lupus vasculitis, drug-induced vasculopathy, postpartum cerebral angiopathy, hypertensive microangiopathy, and Call–Fleming syndrome. All patients with unknown disease origins had favorable outcomes, whereas 8 of 13 patients with an identifiable underlying disorder experienced favorable outcomes.
Conclusions
Spontaneous isolated convexity SAH is rarely caused by aneurysm rupture, has a distinct mode of presentation, and generally carries a more favorable prognosis than that of aneurysmal SAH.
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Affiliation(s)
| | | | | | - Colin P. Derdeyn
- 1Department of Neurosurgery,
- 2Mallinckrodt Institute of Radiology, and
- 3Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri
| | | | - Gregory J. Zipfel
- 1Department of Neurosurgery,
- 3Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri
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Spitzer C, Mull M, Rohde V, Kosinski CM. Non-traumatic cortical subarachnoid haemorrhage: diagnostic work-up and aetiological background. Neuroradiology 2005; 47:525-31. [PMID: 15971064 DOI: 10.1007/s00234-005-1384-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2005] [Accepted: 02/16/2005] [Indexed: 10/25/2022]
Abstract
Only 15% of all subarachnoid haemorrhages (SAHs) are not of aneurysmal origin. Among those, circumscribed SAHs along the cortical convexity are rare and have only been described in singular case reports so far. Here, we present a collection of 12 cases of SAH along the convexity, of non-traumatic origin. Over a period of 10 years, 12 cases of circumscribed SAH along the convexity were identified at our clinic. The clinical presentations, neuroradiological SAH characteristics, further diagnostic work-up to identify the underlying aetiologies, the therapy and clinical outcome were analysed. The patients' chief complaints were unspecific cephalgia, focal or generalised seizures and focal neurological deficits. Typical signs of basal SAH, such as nuchal rigidity, thunderclap-headache or alteration of consciousness, were rare. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) revealed different aetiologies, namely postpartal posterior encephalopathy (three), cerebral vasculitis (two), dural sinus thrombosis (two), cortical venous thrombosis (one), intracerebral abscesses (one) and cerebral cavernoma (one). Two cases remained unresolved. Treatment of the underlying disease and symptomatic medication led to good clinical outcome in almost all cases. On the basis of these findings, we demonstrate that the clinical presentation, localisation and aetiology of cortical SAH differ clearly from other SAHs. A diagnostic work-up with MRI and eventually DSA is essential. Mostly, the causative disease can be identified, and specific treatment allows a favourable outcome.
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Affiliation(s)
- C Spitzer
- Department of Neurology, University Hospital of RWTH Aachen, Germany
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