Journal Article Ppublish 2 citations
PubMed: 42385122 DOI: 10.1212/WNL.0000000000218274
Spatiotemporal Associations Between Cortical Microinfarcts and Cortical Superficial Siderosis in Cerebral Amyloid Angiopathy.
Neurology 107(2):e218274
Authors: Mattia Losa, Maria Clara Zanon Zotin, Thijs W van Harten, Hilde van den Brink, Rhiana Carr, Luca Roccatagliata, Matteo Pardini, Steven M Greenberg, Anand Viswanathan, Susanne J van Veluw, Mariel G Kozberg
Affiliations
- J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston.
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy.
- Center for Imaging Sciences and Medical Physics, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School University of São Paulo, Brazil.
- J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston. BHF-UK DRI Centre for Vascular Dementia Research, University of Edinburgh, Scotland, United Kingdom.
- IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy; and.
- Neuroradiology, Department of Health Sciences, University of Genoa, Italy.
- BHF-UK DRI Centre for Vascular Dementia Research, University of Edinburgh, Scotland, United Kingdom.
Abstract
BACKGROUND AND OBJECTIVES
Cerebral amyloid angiopathy (CAA) is a small vessel disease characterized by hemorrhagic and nonhemorrhagic brain injuries. While cortical cerebral microinfarcts (CMI) have been associated with cortical superficial siderosis (cSS), the mechanisms linking these lesions remain unknown. This study aims to determine the spatiotemporal relationship between cortical CMI and cSS in CAA, with the hypothesis that cSS can promote local ischemic injury.
METHODS
Patients with probable CAA (Boston Criteria v2.0) without previous symptomatic intracerebral hemorrhage or CAA-related inflammation were recruited from a prospective memory clinic-based cohort at Massachusetts General Hospital. CAA-related radiologic manifestations-including cortical CMI and cSS-were quantified at baseline and at the 24-month follow-up on 3-Tesla MRI. Multivariable logistic regression and generalized linear models were applied to assess associations between baseline radiologic features and radiologic progression. We also compared the local density of cortical CMIs in regions with and without overlaid cSS.
RESULTS
Among 74 patients with probable CAA (age: 73.0 [67.9-78.2] years; 38% female), 26 (35%) had cortical CMIs (n = 135, 39% underlying cSS). Compared with CMI-negative CAA, those with CMI had a higher cSS prevalence (73% vs 40%; p = 0.006), cSS volume (1.3 [0.1-8.3] vs 0 [0-0.5] mL; p < 0.001), and lobar lacunes count (50% vs 19%; p = 0.005). At baseline, cortical CMI count demonstrated a nonlinear association with cSS volume (Exp(B) = 1.12 [95% CI 1.07-1.18]; p < 0.001) and with lobar lacunes count (Exp(B) = 1.65 [95% CI 1.52-1.80]; p < 0.001). The CMI density was markedly higher in cSS-covered vs non-cSS regions (median: 20.84 [0.00-56.95] vs 0.49 [0.11-0.89]n° cortical CMI/1,000 cm2; p = 0.010). Follow-up scans (n = 36) revealed 23 incident cortical CMIs (43% underlying cSS). Baseline cSS volume was independently associated with incident CMI (OR:1.41 [95% CI 1.02-1.95]; p = 0.036), whereas baseline CMI burden was not associated with cSS progression.
DISCUSSION
Our findings demonstrate a close interplay between cortical CMI and cSS, with the spatiotemporal relationship supporting the hypothesis that convexity subarachnoid hemorrhage, and potentially resultant cSS, may trigger local ischemic injury. Given the sample size of the longitudinal cohort, we consider these data hypothesis-generating. Further studies should confirm this association and identify the driving pathophysiology, which may represent a new therapeutic target for preventing cSS-associated cortical injury.
MeSH
Hemorrhage, Siderosis, Amyloid, Wounds And Injuries, Cerebral Amyloid Angiopathy, Neurology