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. 2020 Jan;267(1):133-137.
doi: 10.1007/s00415-019-09558-9. Epub 2019 Oct 3.

Clinical features distinguish cerebral amyloid angiopathy-associated convexity subarachnoid haemorrhage from suspected TIA

Joel Elliot Dane Stanton  1 , Arvind Chandratheva  1 , Duncan Wilson  2 , Isabel Charlotte Hostettler  1 , Saiful Islam  3 , David John Werring  4   5
Affiliations

Clinical features distinguish cerebral amyloid angiopathy-associated convexity subarachnoid haemorrhage from suspected TIA

Joel Elliot Dane Stanton et al. J Neurol. 2020 Jan.

Abstract

Objective: To identity clinical features that distinguish between cerebral amyloid angiopathy (CAA)-associated convexity subarachnoid haemorrhage (cSAH) and suspected TIA.

Methods: We undertook a single-centre, retrospective case-control study. We identified cases [patients with cSAH presenting with transient focal neurological episodes (TFNE)] from radiological and clinical databases of patients assessed at the National Hospital for Neurology and Neurosurgery and UCLH Comprehensive Stroke Service. We identified age- and gender-matched controls at a 1:4 ratio from a database of consecutive suspected TIA clinic attendances at UCLH. We compared presenting symptoms and vascular risk factors between cases and controls.

Results: We included 19 patients with cSAH-associated TFNE and 76 matched controls with suspected TIA. Migratory (spreading) symptoms (32% vs. 3%, OR 17.3; p = 0.001), sensory disturbance (47% vs. 14%, OR 5.3; p = 0.003,) and recurrent stereotyped events (47% vs. 19%, OR 3.7; p = 0.02,) occurred more frequently in patients with cSAH compared to controls. Hypercholesterolaemia was less common in patients with cSAH (16% vs 53%, OR 0.17; p = 0.008).

Conclusion: Simple clinical features could help distinguish cSAH-associated TFNE from suspected TIA, with relevance for investigation and management, including the use of antithrombotic drugs.

Keywords: Cerebral amyloid angiopathy; Convexial subarachnoid haemorrhage; Mimic; Non-traumatic convexity subarachnoid haemorrhage; Transient ischaemic attack.

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Conflict of interest statement

Joel Stanton reports no disclosures. Arvind Chandratheva reports no disclosures. Duncan Wilson reports no disclosures. Isabel Charlotte Hostettler reports no disclosures. Saiful Islam reports no disclosures. David John Werring reports personal fees from Bayer.

Figures

Fig. 1
Fig. 1
Flow diagram of patient selection
Fig. 2
Fig. 2
Bar chart showing the frequency of clinical features in cSAH cases and matched controls
See this image and copyright information in PMC

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