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

• Published in: Journal of neurology 2020-01, Vol.267 (1), p.133-137
• Main Authors: Stanton, Joel Elliot Dane, Chandratheva, Arvind, Wilson, Duncan, Hostettler, Isabel Charlotte, Islam, Saiful, Werring, David John
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aneurysms; Case-Control Studies; Cerebral amyloid angiopathy; Cerebral Amyloid Angiopathy - complications; Cerebral Amyloid Angiopathy - diagnosis; Diagnosis, Differential; Female; Humans; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - physiopathology; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Communication; Patients; Retrospective Studies; Risk factors; Stroke; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - etiology; Subarachnoid Hemorrhage - physiopathology; Transient ischemic attack
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-019-09558-9

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.