Cortical Superficial Siderosis and Risk of Recurrent Intracerebral Hemorrhage in Cerebral Amyloid Angiopathy.

University Hospital, Toulouse170 enrolled

Overview

Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage (ICH) in the elderly with high risk of recurrence. The investigators aim to determine the relationship between cortical superficial siderosis (cSS), a MRI hemorrhagic marker of CAA and the risk of symptomatic ICH recurrence in a multicentric prospective cohort of patients with acute lobar ICH related to CAA. The investigators hypothesize that patients with cSS have an increased risk of recurrent symptomatic ICH relative to those without cSS.

Patients with acute lobar ICH fulfilling the Boston criteria for probable or possible CAA will be enrolled within 30 days after ICH onset. Brain MRI performed at baseline will be analyzed blinded to clinical data. Patients with presence of cSS will be compared with those without cSS. During a systematic follow-up of 24 months, patients will undergo neurological, neuropsychological and MRI evaluation. The investigators will compare the rate of recurrent symptomatic ICH at 24 months in patients with vs. without cSS.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

OTHER

Masking

NONE

Enrollment

170

Conditions

Cerebral Amyloid Angiopathy

Interventions

Eligibility

Sex: ALLMin age: 55 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Lobar ICH within 30 days after onset * Available brain MRI sequences of adequate quality including fluid-attenuated inversion recovery (FLAIR) and T2\*-weighted gradient-recalled echo (T2\*-GRE) sequences. * Modified Boston criteria for probable or possible CAA * Age ≥ 55 years * Written consent Exclusion Criteria: * Secondary brain hemorrhage : vascular malformation (arteriovenous malformation, aneurysm, cavernous); cerebral veinous thrombosis; brain tumor; coagulopathy; vasculitis; hemorrhagic infarction, * Infratentorial siderosis * Contraindications to MRI * Neurosurgical intervention before inclusion, * Progressive neoplasm * Patient without affiliation to the french social security * Patient under guardianship

Outcomes

Primary Outcomes

Recurrent symptomatic intracerebral hemorrhage at 24 months

Recurrent symptomatic intracerebral haemorrhage is defined as a further intracerebral hemorrhage documented by CT scan or MRI, associated with new neurologic symptoms

Time frame: 24 months

Secondary Outcomes

Recurrent symptomatic ICH at 12 months

Recurrent symptomatic intracerebral haemorrhage is defined as a further intracerebral hemorrhage documented by CT scan or MRI, associated with new neurologic symptoms.

Time frame: 12 months

Transient Focal Neurological Episodes (TFNE) at 12 and 24 months

TFNE was defined as transient (≤24 hours), with fully resolving, focal neurological symptoms that had no known alternative explanation other than CAA (e.g., structural brain lesion, atrial fibrillation, extracranial, or intracranial stenosis)

Time frame: 12 and 24 months

mortality or dependance at 12 and 24 months

Mortality and dependence defined by a modified Rankin scale \>2

Time frame: 12 and 24 months

Cognitive decline at 12 and 24 months

moderate or severe vascular cognitive disorders (VCD) according to the VASCOG criteria.

Time frame: 12 and 24 months

New MRI hemorrhagic lesion at 12 months

Presence of new symptomatic or asymptomatic hemorrhagic lesion (ICH, microbleeds, convexity subarachnoid hemorrhage) on follow-up MRI at 12 months

Time frame: 12 months

Extent of cortical superficial siderosis at 12 months

Extent of cSS is assessed on follow up MRI at 12 months according to the current guidelines: 0: no cSS; 1: focal cSS (restricted to ≤3 sulci); 2: disseminated cSS (≥4 sulci).

Time frame: 12 months

frequency of APOE ε2 and ε4 allele

frequency of both ε2 and ε4 allele on Apolipoprotein E (APOE) genotype at baseline

Time frame: baseline

Cortical Superficial Siderosis and Risk of Recurrent Intracerebral Hemorrhage in Cerebral Amyloid Angiopathy.

Overview

Conditions

Interventions

Eligibility

Locations (4)

Outcomes

Primary Outcomes

Secondary Outcomes