Clinical, Radiologic Markers Predictive of Cortical Superficial Siderosis in ICH Identified

hemorrhagic stroke
hemorrhagic stroke
Investigators identify clinical and neuroimaging markers associated with the presence of cortical superficial siderosis and the risk for recurrent ICH.

Increasing age, pre-existing dementia, a history of intracerebral hemorrhage (ICH), ICH lobar location, severe white matter hyperintensities score, and an absence of lacune are independent clinical and radiologic markers associated with cortical superficial siderosis (cSS) and underlying cerebral amyloid angiopathy in patients with spontaneous ICH, according to the findings of a prospective observational study published in Neurology.1

Consecutive patients with parenchymal hemorrhage and spontaneous ICH from the observational Prognosis of IntraCerebral Haemorrhage (PITCH) study (n=258) were recruited.2 At baseline, the investigators prospectively obtained data on the presence of vascular risk factors, including whether the patients had a history of stroke or transient ischemic attack (TIA), ischemic heart disease, or atrial fibrillation. The Informant Questionnaire on Cognitive Decline in the Elderly, with a score of >64 defining pre-existing dementia, was used to obtain information on baseline cognitive function. Patients were invited to participant in an in-person or telephone-based follow-up at 6 and 12 months.

At baseline, the prevalence of cSS was 19% (n=49; 95% CI, 14%-24%). The clinical factors independently associated with cSS in the multivariable analysis included a history of ICH (odds ratio [OR] 4.02; 95% CI, 1.25-12.95; P =.020), increasing age (OR 1.03 per 1-year increase; 95% CI, 1.001-1.058; P =.044), and preexisting dementia (OR 2.62; 95% CI, 1.05-6.51; P =.044).

Radiologic factors that were deemed independent predictors for cSS included severe white matter hyperintensities score (OR 5.506; 95% CI, 1.17-5.78; P =.019), ICH lobar location (OR 24.841; 95% CI, 3.2-14.46; P <.001), and absence of lacune (OR 4.46; 95% CI 1.06-5.22; P =.035). In addition, recurrent symptomatic ICH was significantly associated with disseminated cSS on baseline magnetic resonance imaging (MRI) (hazard ratio 4.69; 95% CI, 1.49-14.71; P =.008).

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Limitations of the study include the underestimation of both the prevalence of baseline cSS and the number of ICH recurrences in survivors of ICH due to the exclusion of patients who died prior to discharge, as well as the focus on clinical events only.

The independent markers associated with cSS in this cohort “may provide additional information on ICH recurrence risk assessment with relevance for clinical practice and management of ICH survivors.”


  1. Moulin S, Casolla B, Kuchcinski G, et al. Cortical superficial siderosis: A prospective observational cohort study [published online June 8, 2018]. Neurology. doi:10.1212/WNL.0000000000005778
  2.  Cordonnier C, Rutgers MP, Dumont F, et al. Intra-cerebral haemorrhages: are there any differences in baseline characteristics and intra-hospital mortality between hospital and population-based registries? J Neurol. 2009;256(2):198-202.