Kaiser, Johanna and Schebesch, Karl-Michael and Brawanski, Alexander and Linker, Ralf A. and Schlachetzki, Felix and Wagner, Andrea (2019) Long-Term Follow-Up of Cerebral Amyloid Angiopathy-Associated Intracranial Hemorrhage Reveals a High Prevalence of Atrial Fibrillation. JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 28 (11): 104342. ISSN 1052-3057, 1532-8511
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Goal: Cerebral amyloid angiopathy (CAA) is the second-most common cause of nontraumatic intracerebral hemorrhages (ICH), surpassed only by uncontrolled hypertension. We characterized the percentage, risk factors, and comorbidities of patients suffering from CAA-related ICH in relation to long-term outcomes. Material and Methods: We performed retrospective analyses and clinical follow-ups of individuals suffering from ICH who were directly admitted to neurosurgery between 2002 and 2016. Findings: Seventy-four of 174 (42%) spontaneous nontraumatic lobar ICH cases leastwise satisfied the modified Boston criteria definition for at least "possible CAA." Females suffered a higher risk of CAA-caused ICH (42 of 74, 56.8%, P=.035). Atrial fibrillation as a major comorbidity was observed in 19 patients (25.7%). Recovery (decrease of modified Rankin scale [mRS]) was highest during hospitalization in the acute clinic. One-year mortality was as follows: 14 of 25 patients (56%) with probable CAA without supporting pathology, 6 of 18, and 8 of 31 patients with supporting pathology and possible CAA, respectively. Only 10 of 74 (13.6%) had favorable long-term outcomes (mRS <= 2). Increasing numbers of lobar hemorrhages, low initial Glasgow Coma Scale, and subarachnoid hemorrhage were significantly associated with poor survivability, whereas statins, antithrombotic agents, an intraventricular hemorrhage, and midline shift played seemingly minor roles. Conclusions: Symptomatic ICH is a serious stage in CAA progression with high mortality. The high incidence of concurrent atrial fibrillation in these patients may support data on more widespread vascular pathology in CAA.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | LOBAR INTRACEREBRAL HEMORRHAGE; INITIAL CONSERVATIVE TREATMENT; STATIN USE; SUPERFICIAL SIDEROSIS; EARLY SURGERY; HIGH-RISK; SMASH-U; STROKE; ANTIPLATELET; METAANALYSIS; Cerebral amyloid angiopathy; intracerebral bleeding; atrial fibrillation; long-term outcome; computer tomography; magnetic resonance tomography |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 25 Mar 2020 06:21 |
| Last Modified: | 25 Mar 2020 06:21 |
| URI: | https://pred.uni-regensburg.de/id/eprint/25936 |
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