Abstract 83: Prognostic Value of Cortical Superficial Siderosis Among Patients with Cerebral Amyloid Angiopathy-Associated Intracerebral Hemorrhage

Introduction: The recent update (version 2.0) to the Boston criteria for cerebral amyloid angiopathy (CAA) adds two additional neuroimaging markers to increase the sensitivity of CAA detection: multispot white matter hyperintensity (WMH) pattern and severe centrum semiovale enlarged perivascular spaces (CSO EPVS). While the presence of these novel non-hemorrhagic markers, together with well-established hemorrhagic markers such as lobar cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS), increases the likelihood of underlying CAA in patients with intracerebral hemorrhage (ICH), it is unclear whether these markers have a prognostic impact on clinical outcomes. Methods: Brain MRIs from a prospective database of consecutive non-traumatic ICH patients admitted to a tertiary care center were reviewed for the presence of CMBs, cSS, multispot WMH pattern, and CSO EPVS. Patients who met the diagnostic criteria for CAA were selected for inclusion in this study. Clinical and neuroimaging predictors of an unfavorable discharge outcome (modified Rankin score ≥ 4) were assessed in univariate and multivariable models. Results: Between 2003 and 2019, 1,791 patients were admitted with non-traumatic ICH. Of the 1,297 (72%) patients who received a brain MRI, 645 (36%) were found to have CAA (mean age 74±11 years, 49% female). An unfavorable discharge was observed in 75% of patients. Lobar CMBs occurred in 326 (51%) patients, cSS occurred in 197 (31%), multispot WMH pattern occurred in 123 (19%), and severe centrum semiovale EPVS occurred in 156 (24%). In univariate analyses, age, hypertension, diabetes, ischemic stroke history, dementia, admission Glasgow Coma Scale (GCS) scores, intubation, external ventricular drain placement, hematoma evacuation, intraventricular extension, and cSS were associated with an unfavorable discharge outcome (all p < 0.05). When entered into a multivariable model subjected to backward elimination, age (aOR 1.05, 95% CI 1.03–1.08), hypertension (aOR 1.66, 95% CI 1.06–2.62), dementia (aOR 8.40, 95% CI 1.97–35.81), GCS score (aOR 0.85, 95% CI 0.75–0.96), intubation (aOR 2.59, 95% CI 1.09–6.15), intraventricular extension (aOR 1.75, 95% CI 1.67–4.84), and cSS (aOR 1.75, 95% CI 1.07–2.88) remained significantly associated with an unfavorable discharge outcome. Conclusion: Although non-hemorrhagic imaging markers are common in CAA patients with ICH, only the presence of cSS is significantly associated with unfavorable clinical outcomes.