Spontaneous convexity subarachnoid haemorrhage: Clinical series of 3 patients with associated cerebral amyloid angiopathy.

Abstract

INTRODUCTION:

Convexity subarachnoid haemorrhage (cSAH) is a rare type of spontaneous, non-traumatic, and nonaneurysmal SAH characterised by blood collections in one or more cortical sulci in the convexity of the brain; the aetiology varies. We report a clinical case series of 3 patients with cSAH associated with probable cerebral amyloid angiopathy (CAA) who presented with focal sensory seizures and responded well to corticosteroid treatment.

PATIENTS:

Case 1 was a 67-year-old man reporting right-sided paroxysmal sensory episodes with Jacksonian progression, cheiro-oral symptoms, and motor dysphasia. Case 2 was a 79-year-old man reporting left-sided paroxysmal episodes with cheiro-oral signs and dysarthria. Case 3 was a 71-year-old woman also reporting recurrent left cheiro-oral signs and dysarthria. None of the patients had headache or clinical dementia. Aneurysms were ruled out using MR angiography.

RESULTS:

Brain CT scan detected an isolated hyperintensity in a sulcus of the frontal convexity; brain gradient echo T2-weighted MRI sequences showed meningeal haemosiderosis and microbleeds. However, no atrophy was identified in medial temporal lobes including the hippocampal formation. All patients had low levels of beta-amyloid in CSF, low values on the Hulstaert index and high levels of phosphorylated tau protein. Patients were initially treated with prednisone and levetiracetam, but symptoms recurred in 2 patients after prednisone was discontinued.

CONCLUSIONS:

We present a series of 3 patients with cSAH associated with CAA, characterised by a stereotypical syndrome responding well to corticoid treatment; there were no cases of headache or clinical dementia.

• Authors: D A García Estévez, R M García-Dorrego, B Nieto-Baltar, M Marey-Garrido, T Hierro-Torner
• Journal: Neurologia (Barcelona, Spain) (Neurologia) Vol. 32 Issue 4 Pg. 213-218 (May 2017) ISSN: 1578-1968 [Electronic] Spain
• Vernacular Title: Hemorragia subaracnoidea espontánea de la convexidad cerebral: una serie clínica de 3 pacientes asociada con angiopatía amiloide cerebral.
• PMID: 26778730 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Chemical References

• Anticonvulsants
• Glucocorticoids
• Levetiracetam
• Dexamethasone
• Prednisone
• Piracetam

Topics

• Aged
• Anticonvulsants (therapeutic use)
• Brain
• Cerebral Amyloid Angiopathy (complications, pathology)
• Dexamethasone (therapeutic use)
• Female
• Glucocorticoids (therapeutic use)
• Hemosiderosis
• Humans
• Levetiracetam
• Magnetic Resonance Angiography
• Magnetic Resonance Imaging
• Male
• Piracetam (analogs & derivatives, therapeutic use)
• Prednisone (therapeutic use)
• Subarachnoid Hemorrhage (etiology, pathology)
• Tomography, X-Ray Computed