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Multifocal Atraumatic Convexity Subarachnoid Hemorrhage.

Katarina B Dakay1, Idrees Azher2, Ali Mahta3

  • 1Neurosurgery, Westchester Medical Center, Valhalla, USA.

Cureus
|August 4, 2021
PubMed
Summary

Multifocal convexity subarachnoid hemorrhage (cSAH) is found in 18.6% of cases and can occur without trauma. Reversible cerebral vasoconstriction syndrome (RCVS)/posterior reversible encephalopathy syndrome (PRES) is a common cause, especially in younger patients with thunderclap headaches.

Keywords:
cerebral amyloid angiopathyconvexity subarachnoid hemorrhagemri- magnetic resonance imagingreversible cerebral vasoconstriction syndromesubarachnoid hemorrhage

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Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Multifocal convexity subarachnoid hemorrhage (cSAH) is typically associated with traumatic brain injury.
  • However, cSAH can also occur in non-traumatic conditions like reversible cerebral vasoconstriction syndrome (RCVS).
  • This study characterizes multifocal cSAH in an academic center setting.

Purpose of the Study:

  • To describe the clinical and radiographic features of multifocal cSAH.
  • To identify the underlying etiologies of non-traumatic multifocal cSAH.
  • To highlight the association between multifocal cSAH and RCVS/PRES spectrum.

Main Methods:

  • Retrospective analysis of a single-center database of non-traumatic cSAH from January 2015 to January 2018.
  • Defined cSAH as blood in cortical sulci without trauma, excluding cisterns or Sylvian fissure involvement.
  • Defined multifocal cSAH as at least two distinct foci in two or more lobes; collected clinical and neuroimaging data.

Main Results:

  • 13 out of 70 (18.6%) cSAH cases were multifocal.
  • Mean age was 58 years, with 11 female patients.
  • Etiologies included RCVS/PRES (7), cerebral amyloid angiopathy (CAA) (2), coagulopathy (3), and endocarditis (1). Headache was the most frequent symptom (61.5%).

Conclusions:

  • Multifocal cSAH occurs in 18.6% of cSAH cases and can be non-traumatic.
  • While CAA is common in all cSAH, RCVS/PRES is a more frequent cause of multifocal cSAH.
  • Clinicians should consider RCVS/PRES in patients with multifocal cSAH, especially younger individuals with thunderclap headaches.