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. 2021 Oct;16(7):798-808.
doi: 10.1177/1747493020984559. Epub 2021 Jan 21.

Cortical superficial siderosis in the general population: The Framingham Heart and Rotterdam studies

Ashkan Shoamanesh  1   2 , Saloua Akoudad  3 , Jayandra J Himali  2   4   5   6 , Alexa S Beiser  2   4   5 , Charles DeCarli  7 , Sudha Seshadri  2   4   6 , M Arfan Ikram  3 , Jose R Romero  2 , Meike W Vernooij  3
Affiliations

Cortical superficial siderosis in the general population: The Framingham Heart and Rotterdam studies

Ashkan Shoamanesh et al. Int J Stroke. 2021 Oct.

Abstract

Objective: We aimed to characterize cortical superficial siderosis, its determinants and sequel, in community-dwelling older adults.

Methods: The sample consisted of Framingham (n = 1724; 2000-2009) and Rotterdam (n = 4325; 2005-2013) study participants who underwent brain MRI. In pooled individual-level analysis, we compared baseline characteristics in patients with cortical superficial siderosis to two reference groups: (i) persons without hemorrhagic MRI markers of cerebral amyloid angiopathy (no cortical superficial siderosis and no microbleeds) and (ii) those with presumed cerebral amyloid angiopathy based on the presence of strictly lobar microbleeds but without cortical superficial siderosis.

Results: Among a total of 6049 participants, 4846 did not have any microbleeds or cortical superficial siderosis (80%), 401 had deep/mixed microbleeds (6.6%), 776 had strictly lobar microbleeds without cortical superficial siderosis (12.8%) and 26 had cortical superficial siderosis with/without microbleeds (0.43%). In comparison to participants without microbleeds or cortical superficial siderosis and to those with strictly lobar microbleeds but without cortical superficial siderosis, participants with cortical superficial siderosis were older (OR 1.09 per year, 95% CI 1.05, 1.14; p < 0.001 and 1.04, 95% CI 1.00, 1.09; p = 0.058, respectively), had overrepresentation of the APOE ɛ4 allele (5.19, 2.04, 13.25; p = 0.001 and 3.47, 1.35, 8.92; p = 0.01), and greater prevalence of intracerebral hemorrhage (72.57, 9.12, 577.49; p < 0.001 and 81.49, 3.40, >999.99; p = 0.006). During a mean follow-up of 5.6 years, 42.4% participants with cortical superficial siderosis had a stroke (five intracerebral hemorrhage, two ischemic strokes and four undetermined strokes), 19.2% had transient neurological deficits and 3.8% developed incident dementia.

Conclusion: Our study adds supporting evidence to the association between cortical superficial siderosis and cerebral amyloid angiopathy within the general population. Community-dwelling persons with cortical superficial siderosis may be at high risk for intracerebral hemorrhage and future neurological events.

Keywords: Brain microbleeds; cerebral amyloid angiopathy; cerebral hemorrhage; community; cortical superficial siderosis; stroke facilities.

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Conflict of interest statement

Declaration of conflicting interests

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Map of brain distributions of superficial siderosis in 26 participants.
See this image and copyright information in PMC

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