The following is a summary of “Mechanistic Implications of Cortical Superficial Siderosis in Patients With Mixed Location Intracerebral Hemorrhage and Cerebral Microbleeds,” published in the June 2023 issue of Neurology by Das et al. 

Hypertensive cerebral small vessel disease (HTN-cSVD) is the primary microangiopathy in patients with a mix of lobar and deep cerebral microbleeds (CMBs) and intracerebral hemorrhage (mixed ICH). Researchers conducted a cohort study to examine if cerebral amyloid angiopathy (CAA) contributes to microangiopathy in patients with mixed ICH accompanied by cortical superficial siderosis (cSS), a marker strongly linked to CAA. 

They studied consecutive non-traumatic ICH patients’ Brain MRIs from a referral center’s database. Based on CMBs, cSS, and non-hemorrhagic CAA markers (lobar gaps, centro-ovale enlarged perivascular spaces [CSO-EPVS], white matter hyperintensity (WMH pattern), a univariate and multivariate model was used to compare the frequency of CAA markers and the severity of left ventricular hypertrophy (LVH), a marker of hypertensive end-organ damage, between mixed ICH/cSS [+] and mixed ICH/cSS[–] patients. 

The results showed 1,791 patients with ICH, 40 with mixed ICH/cSS (+), and 256 with mixed ICH/cSS (-). The presence of LVH was lower in mixed ICH/cSS (+) compared to mixed ICH/cSS (-) (34% vs. 59%, P= 0.01). Mixed ICH/cSS(+)-multispot pattern (18% vs. 4%, P=0.01) and severe CSO-EPVS (33% vs. 11%, P=0.01). Logistic regression showed independent associations with mixed ICH/cSS (+): older age (adjusted odds ratio [aOR] 1.04 per year, 95% CI 1.00–1.07, p = 0.04), absence of LVH (aOR 0.41, 95% CI 0.19–0.89, p = 0.02), multispot WMH pattern (aOR 5.25, 95% CI 1.63–16.94, p = 0.01), and severe CSO-EPVS (aOR 4.24, 95% CI 1.78–10.13,  P< 0.01), adjusted for hypertension and coronary artery disease. A hazard ratio of 4.65 (95% CI 1.38–11.38, P= 0.01) was calculated among ICH survivors with mixed ICH/cSS (+) compared to mixed ICH/cSS (-). 

They concluded CAA and ICH warrant confirmation in imaging-based classifications, considering underlying microangiopathy and HTN-cSVD. 

Source: n.neurology.org/content/101/6/e636