Cortical superficial siderosis as the only MRI sign of cerebral amyloid angiopathy

Jennifer Linn, Consultant,
August 25, 2010

With great interest, I read the letter by Dhollander et al. (1). The authors report two cases with convexity subarachnoid hemorrhages,cortical superficial siderosis (SS)and raised b-amyloid load on PIB-PET examination. Based on the absence of micro- and macrobleeds in one patient, they conclude that this case differs from cerebral amyloid angiopathy (CAA). However, I would like to draw attention to recently published findings that SS is very common in patients with histologically proven CAA, and can even constitute the only pathological MRI finding in these patients (2). Modified Boston criteria including SS as a criterion have been proposed (2). In addition, there is upcoming evidence that in elderly patients CAA is the most common underlying pathology for both acute convexity subarachnoid hemorrhages and chronic cortical SS (3). Based on the data available in literature, I conclude that the authors present to typical cases of CAA (with or without additional Alzheimers disease).

1 Dhollander I, Nelissen N, Van Laere K, Peeters D, Demaerel P, Van Paesschen W, Thijs V, Vandenberghe R.In vivo amyloid imaging in cortical superficial siderosis. J Neurol Neurosurg Psychiatry. 2010 Jul 28.

2 Linn J, Halpin A, Demaerel P, Ruhland J, Giese AD, Dichgans M, van Buchem MA, Bruckmann H, Greenberg SM. Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy. Neurology. 2010;74:1346-50.

3 Kumar S, Goddeau RP Jr, Selim MH, Thomas A, Schlaug G, Alhazzani A, Searls DE, Caplan LR.Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies. Neurology. 2010;74:893-9.

Conflict of Interest:

None declared

Conflict of Interest

None declared