Incidence of Convexal Subarachnoid Hemorrhage in the Elderly: The Mayo Clinic Study of Aging

Micah Yost, Catherine Arnold Fiebelkorn, Alejandro A. Rabinstein, James Klaas, Jeremiah A. Aakre, Robert D. Brown, Michelle M. Mielke, David S. Knopman, Val Lowe, Ronald C. Petersen, Clifford R. Jack, Prashanthi Vemuri, Jonathan Graff-Radford

Research output: Contribution to journalArticle

Abstract

Objectives: Nontraumatic convexal subarachnoid hemorrhages in the elderly can be a manifestation of cerebral amyloid angiopathy associated with a high risk of future intracerebral hemorrhage. The incidence in the elderly population is unknown. Our objectives were to: 1) determine the incidence of convexal subarachnoid hemorrhage in a population-based study, and, 2) to compare apopolipoprotein-E genotype and amyloid positron emission tomographic (PET) imaging for those with versus without hemorrhage. Methods: Between 11/29/2004 and 3/11/2017, 4462 individuals without hemorrhage at baseline participated in the population-based Mayo Clinic Study of Aging. We used the Rochester Epidemiology Project medical records-linkage system to identify intracerebral hemorrhages. Records and images were reviewed to identify convexal subarachnoid hemorrhage. Neuroimaging characteristics, demographics, medications, and apopolipoprotein-E genotype were recorded. Results: Four cases were identified. The incidence of convexal subarachnoid hemorrhage was 14.1 per 100,000 person years. Three occurred in women, median age, 79 (range: 71-84). One patient had coexisting cerebral microbleeds. Two participants developed a subsequent lobar intracerebral hemorrhage at a median of 4.75 years after convexal subarachnoid hemorrhage. The apopolipoprotein-E -allele combinations of the 4 were: 3/3, 3/3, 2/2, and 2/3. On Pittsburgh Compound B-PET imaging, median standardized uptake value ratio with convexal subarachnoid hemorrhage was 1.86 (range: 1.38-2.34). Conclusions: Convexal subarachnoid hemorrhage is rare in the older population, occurring with an incidence of about 14 per 100,000 person years. Yet, when present, it may be associated with a high risk of future intracerebral hemorrhage.

Original languageEnglish (US)
Article number104451
JournalJournal of Stroke and Cerebrovascular Diseases
Volume28
Issue number12
DOIs
StatePublished - Dec 2019

Fingerprint

Subarachnoid Hemorrhage
Cerebral Hemorrhage
Incidence
Population
Medical Record Linkage
Genotype
Cerebral Amyloid Angiopathy
Electrons
Hemorrhage
Amyloid
Neuroimaging
Epidemiology
Alleles
Demography

Keywords

  • amyloid PiB PET
  • apopolipoprotein-E (APOE) e2
  • cerebral amyloid angiopathy
  • Convexal subarachnoid hemorrhage
  • convexity subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Incidence of Convexal Subarachnoid Hemorrhage in the Elderly : The Mayo Clinic Study of Aging. / Yost, Micah; Fiebelkorn, Catherine Arnold; Rabinstein, Alejandro A.; Klaas, James; Aakre, Jeremiah A.; Brown, Robert D.; Mielke, Michelle M.; Knopman, David S.; Lowe, Val; Petersen, Ronald C.; Jack, Clifford R.; Vemuri, Prashanthi; Graff-Radford, Jonathan.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 28, No. 12, 104451, 12.2019.

Research output: Contribution to journalArticle

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abstract = "Objectives: Nontraumatic convexal subarachnoid hemorrhages in the elderly can be a manifestation of cerebral amyloid angiopathy associated with a high risk of future intracerebral hemorrhage. The incidence in the elderly population is unknown. Our objectives were to: 1) determine the incidence of convexal subarachnoid hemorrhage in a population-based study, and, 2) to compare apopolipoprotein-E genotype and amyloid positron emission tomographic (PET) imaging for those with versus without hemorrhage. Methods: Between 11/29/2004 and 3/11/2017, 4462 individuals without hemorrhage at baseline participated in the population-based Mayo Clinic Study of Aging. We used the Rochester Epidemiology Project medical records-linkage system to identify intracerebral hemorrhages. Records and images were reviewed to identify convexal subarachnoid hemorrhage. Neuroimaging characteristics, demographics, medications, and apopolipoprotein-E genotype were recorded. Results: Four cases were identified. The incidence of convexal subarachnoid hemorrhage was 14.1 per 100,000 person years. Three occurred in women, median age, 79 (range: 71-84). One patient had coexisting cerebral microbleeds. Two participants developed a subsequent lobar intracerebral hemorrhage at a median of 4.75 years after convexal subarachnoid hemorrhage. The apopolipoprotein-E -allele combinations of the 4 were: 3/3, 3/3, 2/2, and 2/3. On Pittsburgh Compound B-PET imaging, median standardized uptake value ratio with convexal subarachnoid hemorrhage was 1.86 (range: 1.38-2.34). Conclusions: Convexal subarachnoid hemorrhage is rare in the older population, occurring with an incidence of about 14 per 100,000 person years. Yet, when present, it may be associated with a high risk of future intracerebral hemorrhage.",
keywords = "amyloid PiB PET, apopolipoprotein-E (APOE) e2, cerebral amyloid angiopathy, Convexal subarachnoid hemorrhage, convexity subarachnoid hemorrhage",
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AU - Yost, Micah

AU - Fiebelkorn, Catherine Arnold

AU - Rabinstein, Alejandro A.

AU - Klaas, James

AU - Aakre, Jeremiah A.

AU - Brown, Robert D.

AU - Mielke, Michelle M.

AU - Knopman, David S.

AU - Lowe, Val

AU - Petersen, Ronald C.

AU - Jack, Clifford R.

AU - Vemuri, Prashanthi

AU - Graff-Radford, Jonathan

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KW - convexity subarachnoid hemorrhage

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