Abstract
Supratentorial superficial siderosis (SS) is a frequent imaging marker of cerebral amyloid angiopathy (CAA). It is most probably caused by focal subarachnoid hemorrhages (fSAHs). Based on single-case observations, it has been proposed that such fSAHs might be a predisposing factor for future intracranial hemorrhage. Here we tested the hypothesis if a SS as a residue of fSAHs must be regarded as a warning sign for future intracranial hemorrhage. Fifty-one consecutive patients with SS and no apparent cause other than possible or probable CAA were identified through a database search and followed-up for a median interval of 35.3 months (range 6–120 months). Main outcome measures were rate and location of new intracranial hemorrhages. Twenty-four patients (47.1 %) had experienced any new intracranial hemorrhage, 18 patients (35.3 %) had an intracerebral hemorrhage (ICH), and in 13 of them (25.5 %), the hemorrhage was located at the site of pre-existing siderosis. Six patients (11.7 %) had developed a new subarachnoid hemorrhage (SAH), four of them at the site of siderosis. Patients with SS are at substantial risk for subsequent intracranial hemorrhage. SS can be considered a warning sign of future ICH or SAH, which frequently occur adjacent to pre-existing SS. Prospective studies are needed to confirm these findings.
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We would like to thank all the patients and their guardians for participating in this study.
Conflicts of interest
The authors declare that they have no conflict of interest related to this study. Dr. Dichgans is a consultant for the following companies: Bayer Vital GmbH, Boehringer Ingelheim Pharma GmbH & Co. KG, Biologische Heilmittel Heel GmbH, Bristol-Myers Squibb GmbH & Co. KgaA, and Trommsdorff GmbH & Co. KG. Honoraria he gets from Bayer Vital GmbH, Boehringer Ingelheim Pharma GmbH & Co. KG, Biologische Heilmittel Heel GmbH, Bristol-Myers Squibb GmbH & Co. KgaA, Lundbeck GmbH, Sanofi-Aventis Deutschland GmbH, Shire Deutschland GmbH, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Georg Thieme Verlag KG, UpToDate, and W. Kohlhammer GmbH. He acts as principal investigator or gets research funding from Bayer Vital GmbH, Eisai Medical Research Inc., Eisai Ltd., Essex Pharma GmbH, Ferrer Internacional, S.A., and ICOn Clinical Research GmbH. Dr. Opherk has served on scientific advisors boards for Boehringer-Ingelheim Pharma GmbH & Co. KG and Bristol-Myers Squibb GmbH & Co. KgaA and has received speaker honoraria from Boehringer-Ingelheim Pharma GmbH & Co. KG. All other authors declare that they have no conflict of interest unrelated to this study.
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The study has been approved by the appropiate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
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Linn, J., Wollenweber, F.A., Lummel, N. et al. Superficial siderosis is a warning sign for future intracranial hemorrhage. J Neurol 260, 176–181 (2013). https://doi.org/10.1007/s00415-012-6610-7
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DOI: https://doi.org/10.1007/s00415-012-6610-7