Cortical superficial siderosis: A prospective observational cohort study

Area of Science:

• Neurology
• Neuroimaging
• Vascular Neurology

Background:

• Cortical superficial siderosis (cSS) is a marker of cerebral amyloid angiopathy (CAA).
• The prevalence, associated factors, and prognostic significance of cSS in intracerebral hemorrhage (ICH) are not fully understood.

Purpose of the Study:

• To determine the prevalence of cSS in a prospective ICH cohort.
• To identify clinical and neuroimaging markers associated with cSS.
• To evaluate the influence of cSS on the risk of recurrent ICH.

Main Methods:

• Prospective observational study of 258 patients with spontaneous ICH.
• Multivariable analysis to identify clinical and radiologic markers of cSS.
• Cox proportional hazards models to assess the association between cSS and recurrent ICH.

Main Results:

• 19% of patients had cSS at baseline.
• Independent predictors of cSS included older age, pre-existing dementia, prior ICH, lobar ICH location, severe white matter hyperintensities, and absence of lacunes.
• Disseminated cSS, but not focal cSS, was significantly associated with an increased risk of recurrent ICH (HR 4.69).

Conclusions:

• Clinical and radiologic markers of cSS suggest underlying cerebral amyloid angiopathy in ICH patients.
• Disseminated cSS is a significant prognostic neuroimaging marker for recurrent ICH.
• Disseminated cSS may be a valuable target for monitoring in future ICH clinical trials.