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Transient Focal Neurological Events in Cerebral Amyloid Angiopathy and the Long-term Risk of Intracerebral Hemorrhage and DeathA Systematic Review and Meta-analysis

Educational Objective
To determine the risk factors of lobar intracerebral hemorrhage and death after a transient focal neurologic episode in patients with cerebral amyloid angiopathy.
1 Credit CME
Key Points

Question  What are the risk factors for lobar intracerebral hemorrhage and death after a transient focal neurological episode (TFNE) in cerebral amyloid angiopathy?

Findings  In this pooled analysis of a systematic review and individual participant meta-analysis and a hospital-based cohort including 248 adults with cerebral amyloid angiopathy (CAA)–associated TFNEs, motor TFNEs and antithrombotics use were associated with an increase in risk of lobar intracerebral hemorrhage. Intracerebral hemorrhage and cortical superficial siderosis were associated with higher mortality rates.

Meaning  The findings from this study show that antithrombotics use after a TFNE and motor TFNEs may be 2 novel hemorrhage risk markers in CAA; this work may help stratify hemorrhage and risk of death in patients with CAA.

Abstract

Importance  Transient focal neurological episodes (TFNEs) are a frequently overlooked presentation of cerebral amyloid angiopathy (CAA), a condition with prognostic implications that are still not well described.

Objective  To perform a systematic review and meta-analysis to examine the factors associated with incident lobar intracerebral hemorrhage (ICH) and death in patients with CAA presenting with TFNEs.

Data Sources  A systematic review and individual participant meta-analysis including (1) a hospital-based cohort and (2) the results obtained from a systematic search performed in MEDLINE and Embase completed in December 2019.

Study Selection  Included studies were observational reports of TFNEs. Patient-level clinical, imaging, and prognostic data were required for inclusion. For aggregate data studies, patient-level data were requested. Disagreements were resolved by consensus.

Data Extraction and Synthesis  Data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines by 4 independent reviewers. The quality of reports was determined based on the modified Pearson Case Report Quality Scale.

Main Outcomes and Measures  The clinical characteristics of TFNEs, neuroimaging features, and use of antithrombotics during follow-up were considered exposures. The predefined main outcomes were lobar ICH and risk of death during follow-up.

Results  Forty-two studies and 222 CAA-associated TFNE cases were included from the initial 1612 records produced by the systematic search; 26 additional patients (11 men [42.3%]; mean [SD] age, 77 [8] years) were provided by the hospital-based cohort. A total of 108 TFNEs (43.5%) consisted of motor symptoms. Convexity subarachnoid hemorrhage and cortical superficial siderosis were detected in 193 individuals (77.8%) and 156 individuals (62.9%) in the systematic search and hospital-based cohort, respectively. Follow-up duration could be obtained in 185 patients (median duration, 1 year [IQR, 0.8-2.5 years]). During follow-up, symptomatic lobar ICH occurred in 76 patients (39.4%). Motor symptoms (odds ratio, 2.08 [95% CI, 1.16-3.70]) at baseline and antithrombotic use during follow-up (odds ratio, 3.61 [95% CI, 1.67-7.84]) were associated with an increase in risk of lobar ICH. A total of 31 patients (16.5%) died during follow-up; lobar ICH during follow-up and cortical superficial siderosis were the main risk factors for death (odds ratio, 3.01 [95% CI, 1.36-6.69]; odds ratio, 3.20 [95% CI, 1.16-8.91], respectively).

Conclusions and Relevance  Patients presenting with CAA-associated TFNEs are at high risk of lobar ICH and death. Motor TFNEs and use of antithrombotics after a TFNE, in many cases because of misdiagnosis, are risk factors for ICH, and therefore accurate diagnosis and distinguishing this condition from transient ischemic attacks is critical.

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Article Information

Accepted for Publication: September 11, 2021.

Published Online: November 15, 2021. doi:10.1001/jamaneurol.2021.3989

Corresponding Author: Jorge Rodríguez-Pardo, MD, PhD, Department of Neurology, Hospital La Paz Institute for Health Research–IdiPAZ (La Paz University Hospital–Universidad Autónoma de Madrid), Paseo de la Castellana 261, 28046, Madrid, Spain (jrpardodedonlebun@salud.madrid.org).

Author Contributions: Drs Rodríguez-Pardo and Sánchez-Caro had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sanchez-Caro, Fuentes, Diez-Tejedor, Rodríguez-Pardo.

Acquisition, analysis, or interpretation of data: Sanchez-Caro, de Lorenzo, de Celis Ruiz, Barguilla, Calviere, Raposo, Galiano Blancart, Rodríguez-Pardo.

Drafting of the manuscript: Sanchez-Caro, Rodríguez-Pardo.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Sanchez-Caro.

Administrative, technical, or material support: Sanchez-Caro, de Lorenzo, Barguilla.

Supervision: Sanchez-Caro, Fuentes, Diez-Tejedor, Rodríguez-Pardo.

Conflict of Interest Disclosures: Dr Calviere reported nonfinancial support from Pfizer and Boehringer Ingelheim and personal fees from Pfizer–Bristol Myers Squibb outside the submitted work. No other disclosures were reported.

Additional Contributions: This study was promoted by the INVICTUS-Plus Spanish Network of the ISCIII (RD16/0019/0005) and the European Regional Development Fund. These networks facilitated the cooperation between investigators but did not fund any aspect of the study. We appreciate the support of Morote Traducciones SL for their editing assistance.

References
1.
Greenberg  SM , Vonsattel  JP , Stakes  JW , Gruber  M , Finklestein  SP .  The clinical spectrum of cerebral amyloid angiopathy: presentations without lobar hemorrhage.   Neurology. 1993;43(10):2073-2079. https://www.ncbi.nlm.nih.gov/pubmed/8413970. doi:10.1212/WNL.43.10.2073 PubMedGoogle ScholarCrossref
2.
Charidimou  A , Peeters  A , Fox  Z ,  et al.  Spectrum of transient focal neurological episodes in cerebral amyloid angiopathy: multicentre magnetic resonance imaging cohort study and meta-analysis.   Stroke. 2012;43(9):2324-2330. doi:10.1161/STROKEAHA.112.657759 PubMedGoogle ScholarCrossref
3.
Illsley  A , Ramadan  H .  Cerebral amyloid angiopathy: a transient ischaemic attack mimic.   Clin Med (Lond). 2014;14(3):255-259. doi:10.7861/clinmedicine.14-3-255 PubMedGoogle ScholarCrossref
4.
Izenberg  A , Aviv  RI , Demaerschalk  BM ,  et al.  Crescendo transient aura attacks: a transient ischemic attack mimic caused by focal subarachnoid hemorrhage.   Stroke. 2009;40(12):3725-3729. doi:10.1161/STROKEAHA.109.557009 PubMedGoogle ScholarCrossref
5.
Barros-Araújo  ML , Nogueira  MRS , Holanda  GMGM , Sousa  ÍA , Corrêa  MR , Cronemberger  PJLA .  Transient focal neurological episodes—“amyloid spells”: a TIA mimic that should be recognized.   Arq Neuropsiquiatr. 2020;78(1):56-57. doi:10.1590/0004-282x20190113 PubMedGoogle ScholarCrossref
6.
Kirshner  HS , Bradshaw  M .  The inflammatory form of cerebral amyloid angiopathy or “cerebral amyloid angiopathy-related inflammation” (CAARI).   Curr Neurol Neurosci Rep. 2015;15(8):54. doi:10.1007/s11910-015-0572-y PubMedGoogle ScholarCrossref
7.
Charidimou  A .  Cerebral amyloid angiopathy-related transient focal neurological episodes (CAA-TFNEs): A well-defined clinical-radiological syndrome.   J Neurol Sci. 2019;2019(406):2019-2021. doi:10.1016/j.jns.2019.116496 PubMedGoogle Scholar
8.
Ni  J , Auriel  E , Jindal  J ,  et al.  The characteristics of superficial siderosis and convexity subarachnoid hemorrhage and clinical relevance in suspected cerebral amyloid angiopathy.   Cerebrovasc Dis. 2015;39(5-6):278-286. doi:10.1159/000381223 PubMedGoogle ScholarCrossref
9.
Raposo  N , Calviere  L , Cazzola  V ,  et al.  Cortical superficial siderosis and acute convexity subarachnoid hemorrhage in cerebral amyloid angiopathy.   Eur J Neurol. 2018;25(2):253-259. doi:10.1111/ene.13484 PubMedGoogle ScholarCrossref
10.
Raposo  N , Viguier  A , Cuvinciuc  V ,  et al.  Cortical subarachnoid haemorrhage in the elderly: a recurrent event probably related to cerebral amyloid angiopathy.   Eur J Neurol. 2011;18(4):597-603. doi:10.1111/j.1468-1331.2010.03214.x PubMedGoogle ScholarCrossref
11.
Majersik  JJ .  Inherited and uncommon causes of stroke.   Continuum (Minneap Minn). 2017;23(1, Cerebrovascular Disease):211-237. doi:10.1212/CON.0000000000000432PubMedGoogle Scholar
12.
von Elm  E , Altman  DG , Egger  M , Pocock  SJ , Gøtzsche  PC , Vandenbroucke  JP ; STROBE Initiative.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.   PLoS Med. 2007;4(10):1623-1627. doi:10.1371/journal.pmed.0040296 PubMedGoogle ScholarCrossref
13.
Greenberg  SM , Charidimou  A .  Diagnosis of cerebral amyloid angiopathy: evolution of the Boston criteria.   Stroke. 2018;49(2):491-497. doi:10.1161/STROKEAHA.117.016990 PubMedGoogle ScholarCrossref
14.
Auriel  E , Charidimou  A , Gurol  ME ,  et al.  Validation of clinicoradiological criteria for the diagnosis of cerebral amyloid angiopathy-related inflammation.   JAMA Neurol. 2016;73(2):197-202. doi:10.1001/jamaneurol.2015.4078 PubMedGoogle ScholarCrossref
15.
Stewart  LA , Clarke  M , Rovers  M ,  et al; PRISMA-IPD Development Group.  Preferred reporting items for a systematic review and meta-analysis of individual participant data: the PRISMA-IPD statement.   JAMA. 2015;313(16):1657-1665. doi:10.1001/jama.2015.3656 PubMedGoogle ScholarCrossref
16.
Rathbone  J , Hoffmann  T , Glasziou  P .  Faster title and abstract screening? evaluating Abstrackr, a semi-automated online screening program for systematic reviewers.   Syst Rev. 2015;4:80. doi:10.1186/s13643-015-0067-6 PubMedGoogle ScholarCrossref
17.
Murad  MH , Sultan  S , Haffar  S , Bazerbachi  F .  Methodological quality and synthesis of case series and case reports.   BMJ Evid Based Med. 2018;23(2):60-63. doi:10.1136/bmjebm-2017-110853 PubMedGoogle ScholarCrossref
18.
Vales-Montero  M , García-Pastor  A , Iglesias-Mohedano  AM ,  et al.  Cerebral amyloid angiopathy-related transient focal neurological episodes: A transient ischemic attack mimic with an increased risk of intracranial hemorrhage.   J Neurol Sci. 2019;406:116452. doi:10.1016/j.jns.2019.116452 PubMedGoogle Scholar
19.
Gujrati  Y , Chuang  D , De Georgia  M .  Convexity SAH and multiple punctate infarcts secondary to cerebral amyloid angiopathy (P1.289).   Neurology. 2017;88(16)(suppl).Google Scholar
20.
Alexander  M , Patil  AK , Mathew  V , Sivadasan  A , Chacko  G , Mani  SE .  Recurrent craniospinal subarachnoid hemorrhage in cerebral amyloid angiopathy.   Ann Indian Acad Neurol. 2013;16(1):97-99. doi:10.4103/0972-2327.107712 PubMedGoogle ScholarCrossref
21.
Duodu  Y , Mathews  S , El Tawil  S .  Cerebral amyloid angiopathy (CAA), an often missed cause of intracranial bleeding.   J Neurol Sci. 2013;333:e244-e245. doi:10.1016/j.jns.2013.07.949Google ScholarCrossref
22.
 Case reports and interesting cases.   International Journal of Stroke. 2010;5(3_suppl):22-23. doi:10.1111/j.1747-4949.2010.00494.x Google ScholarCrossref
23.
Jabri  H , Baral  S , Mamillapalli  CK , Fratianni  CM .  Facial flushing as a presentation of cerebral amyloid angiopathy: an overlooked cause of spells.   Endocr Rev. 2017;38(3):2017-2019.Google Scholar
24.
Mendonça  MD , Caetano  A , Pinto  M , Cruz e Silva  V , Viana-Baptista  M .  Stroke-like episodes heralding a reversible encephalopathy: microbleeds as the key to the diagnosis of cerebral amyloid angiopathy-related inflammation-a case report and literature review.   J Stroke Cerebrovasc Dis. 2015;24(9):e245-e250. doi:10.1016/j.jstrokecerebrovasdis.2015.04.042 PubMedGoogle ScholarCrossref
25.
Goltz  D , Cheng  D , Black  K , Salamon  E , Wright  P .  Transient focal neurological episodes with subsequent catastrophic intracerebral hemorrhage due to cortical superficial siderosis and amyloid angiopathy (P1.233).   Neurology. 2018;90(15)(suppl).Google Scholar
26.
Mao  DQ , Addess  D , Valsamis  H .  A report of nontraumatic cortical subarachnoid hemorrhage and subsequent management.   Future Neurol. 2016;11(4):231-235. doi:10.2217/fnl-2016-0016 PubMedGoogle ScholarCrossref
27.
Alagoz  AN , Can Ucaroglu  N , Boluk  A .  Poster presentations.   Int J Stroke. 2014;9(3):41-331. doi:10.1111/IJS.12367Google Scholar
28.
Refai  D , Botros  JA , Strom  RG , Derdeyn  CP , Sharma  A , Zipfel  GJ .  Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course.   J Neurosurg. 2008;109(6):1034-1041. doi:10.3171/JNS.2008.109.12.1034 PubMedGoogle ScholarCrossref
29.
MacLean  MH , Giesbrecht  B .  Irrelevant reward and selection histories have different influences on task-relevant attentional selection.   Atten Percept Psychophys. 2015;77(5):1515-1528. doi:10.3758/s13414-015-0851-3 PubMedGoogle ScholarCrossref
30.
Calviere  L , Cuvinciuc  V , Raposo  N ,  et al.  Acute convexity subarachnoid hemorrhage related to cerebral amyloid angiopathy: clinicoradiological features and outcome.   J Stroke Cerebrovasc Dis. 2016;25(5):1009-1016. doi:10.1016/j.jstrokecerebrovasdis.2015.11.010 PubMedGoogle ScholarCrossref
31.
Galiano Blancart  RF , Fortea  G , Pampliega Pérez  A ,  et al; por el Grupo Ictus-Comunidad Valenciana.  Pronóstico al año de la hemorragia subaracnoidea cortical no traumática: serie prospectiva de 34 pacientes.   Neurologia (Engl Ed). 2021;36(3):215-221. doi:10.1016/j.nrl.2017.12.008 PubMedGoogle ScholarCrossref
32.
Brunot  S , Osseby  GV , Rouaud  O ,  et al.  Transient ischaemic attack mimics revealing focal subarachnoid haemorrhage.   Cerebrovasc Dis. 2010;30(6):597-601. doi:10.1159/000319780 PubMedGoogle ScholarCrossref
33.
Paterson  RW , Uchino  K , Emsley  HC , Pullicino  P ; RW P.  Recurrent stereotyped episodes in cerebral amyloid angiopathy: response to migraine prophylaxis in two patients.   Cerebrovasc Dis Extra. 2013;3(1):81-84. doi:10.1159/000347114 PubMedGoogle ScholarCrossref
34.
Ahn  SH , Lee  JH , Kim  JS ; SH A.  An elderly patient with recurrent episodes of hemi-paresthesia”: cerebral amyloid angiopathy (CAA).   Eur Neurol. 2015;73(3-4):171-172. doi:10.1159/000367843 PubMedGoogle ScholarCrossref
35.
Hurford  R , Charidimou  A , Werring  D .  Symptomatic lobar intracerebral haemorrhage preceded by transient focal neurological episodes.   BMJ Case Rep. 2013;2013:bcr2013008687. doi:10.1136/bcr-2013-008687 PubMedGoogle Scholar
36.
Katoh  M , Yoshino  M , Asaoka  K ,  et al.  A restricted subarachnoid hemorrhage in the cortical sulcus in cerebral amyloid angiopathy: could it be a warning sign?   Surg Neurol. 2007;68(4):457-460. doi:10.1016/j.surneu.2006.11.028 PubMedGoogle ScholarCrossref
37.
Tocco  P , Moretto  G , Bovi  P .  Cerebral amyloid angiopathy presenting with TIA-like episodes.   Can J Neurol Sci. 2013;40(3):437-438. doi:10.1017/S0317167100017613 PubMedGoogle ScholarCrossref
38.
Cano  LM , Martínez-Yélamos  S , Majós  C ,  et al.  Reversible acute leukoencephalopathy as a form of presentation in cerebral amyloid angiopathy.   J Neurol Sci. 2010;288(1-2):190-193. doi:10.1016/j.jns.2009.09.035 PubMedGoogle ScholarCrossref
39.
García Estévez  DA , García-Dorrego  RM , Nieto-Baltar  B , Marey-Garrido  M , Hierro-Torner  T .  Hemorragia subaracnoidea espontánea de la convexidad cerebral: una serie clínica de 3 pacientes asociada con angiopatía amiloide cerebral.   Neurologia. 2017;32(4):213-218. doi:10.1016/j.nrl.2015.11.004 PubMedGoogle ScholarCrossref
40.
Xu  J , Macdonald  PR , Khanna  AY .  Cerebral amyloid angiopathy with asymmetric superficial hemosiderosis and transient focal neurological symptoms.   Neurohospitalist. 2013;3(2):100. doi:10.1177/1941874412474020 PubMedGoogle ScholarCrossref
41.
Cuinat  L , Nasr  N , Kamsu  JM , Tanchoux  F , Bonneville  F , Larrue  V .  Meningeal disease masquerading as transient ischemic attack.   J Stroke Cerebrovasc Dis. 2014;23(6):1738-1743. doi:10.1016/j.jstrokecerebrovasdis.2014.01.006 PubMedGoogle ScholarCrossref
42.
Samanci  B , Coban  O , Baykan  B .  Late onset aura may herald cerebral amyloid angiopathy: a case report.   Cephalalgia. 2016;36(10):998-1001. doi:10.1177/0333102415620253 PubMedGoogle ScholarCrossref
43.
Calvo  M , de Miguel  C , Pinel  A , Ortega  J , Aladro  Y .  Siderosis superficial difusa del sistema nervioso central: descripción de cuatro casos y revisión de la bibliografía.   Rev Neurol. 2014;59(8):354-358. doi:10.33588/rn.5908.2014234 PubMedGoogle Scholar
44.
Tamura  R , Tomita  H , Mizutani  K , Miwa  T .  The importance of amyloid β protein in cerebrospinal fluid when you recognize convexal subarachnoid hemorrhage.   Eur Neurol. 2014;71(5-6):283-287. doi:10.1159/000357426 PubMedGoogle ScholarCrossref
45.
Salam  S , Anandarajah  M , Al-Bachari  S , Pal  P , Sussman  J , Hamdalla  H .  Relapsing cerebral amyloid angiopathy-related inflammation: the wax and the wane.   Pract Neurol. 2017;17(5):392-395. doi:10.1136/practneurol-2017-001599 PubMedGoogle ScholarCrossref
46.
Roch  JA , Nighoghossian  N , Hermier  M ,  et al.  Transient neurologic symptoms related to cerebral amyloid angiopathy: usefulness of T2*-weighted imaging.   Cerebrovasc Dis. 2005;20(5):412-414. doi:10.1159/000088665 PubMedGoogle ScholarCrossref
47.
Ly  JV , Singhal  S , Rowe  CC , Kempster  P , Bower  S , Phan  TG .  Convexity subarachnoid hemorrhage with pib positive pet scans: clinical features and prognosis.   J Neuroimaging. 2015;25(3):420-429. doi:10.1111/jon.12188 PubMedGoogle ScholarCrossref
48.
Caetano  A , Pinto  M , Calado  S , Viana-Baptista  M .  Amyloid spells and high blood pressure: imminent danger?   Case Rep Neurol. 2015;7(1):39-43. doi:10.1159/000369922 PubMedGoogle ScholarCrossref
49.
Brunot  S , Fromont  A , Ricolfi  F , Moreau  T , Giroud  M .  [Focal subarachnoid hemorrhage and cerebral amyloid angiopathy: a non-fortuitous association].  Rev Neurol (Paris). 2010;166(1):83-89. doi:10.1016/j.neurol.2009.01.037 PubMedGoogle ScholarCrossref
50.
Coates  R , Bell  SM , Coley  S , Blackburn  DJ ; R C.  Cerebral amyloid angiopathy: amyloid spells and cortical superficial siderosis.   Pract Neurol. 2015;15(2):124-126. doi:10.1136/practneurol-2014-000952 PubMedGoogle ScholarCrossref
51.
Gasca-Salas  C , García de Eulate  R , Pastor  P .  [The use of SWI-MRI to differentiate between seizures and transient ischemic attacks in a patient with cerebral amyloid angiopathy].   An Sist Sanit Navar. 2011;34(2):317-321. doi:10.4321/S1137-66272011000200020 PubMedGoogle ScholarCrossref
52.
Zhao  H , Han  J , Lu  M , Zhang  Y , Fan  D .  Incidence and possible causes of nontraumatic convexal subarachnoid haemorrhage in Chinese patients: a retrospective review.   J Int Med Res. 2017;45(6):1870-1878. doi:10.1177/0300060516651987 PubMedGoogle ScholarCrossref
53.
Nakajima  M , Inatomi  Y , Yonehara  T , Hirano  T , Ando  Y .  Nontraumatic convexal subarachnoid hemorrhage concomitant with acute ischemic stroke.   J Stroke Cerebrovasc Dis. 2014;23(6):1564-1570. doi:10.1016/j.jstrokecerebrovasdis.2013.12.046 PubMedGoogle ScholarCrossref
54.
Safouris  A , Gazagnes  MD , Triantafyllou  N , Tsivgoulis  G .  Cerebral amyloid angiopathy-associated microbleed mimicking transient ischemic attack.   J Neurol Sci. 2015;351(1-2):198-199. doi:10.1016/j.jns.2015.02.032 PubMedGoogle ScholarCrossref
55.
Smith  DB , Hitchcock  M , Philpott  PJ .  Cerebral amyloid angiopathy presenting as transient ischemic attacks. case report.   J Neurosurg. 1985;63(6):963-964. doi:10.3171/jns.1985.63.6.0963 PubMedGoogle ScholarCrossref
56.
Apoil  M , Cogez  J , Dubuc  L ,  et al.  Focal cortical subarachnoid hemorrhage revealed by recurrent paresthesias: a clinico-radiological syndrome strongly associated with cerebral amyloid angiopathy.   Cerebrovasc Dis. 2013;36(2):139-144. doi:10.1159/000353676 PubMedGoogle ScholarCrossref
57.
Sharma  R , Dearaugo  S , Infeld  B , O’Sullivan  R , Gerraty  RP .  Cerebral amyloid angiopathy: Review of clinico-radiological features and mimics.   J Med Imaging Radiat Oncol. 2018;62(4):451-463. doi:10.1111/1754-9485.12726 PubMedGoogle ScholarCrossref
58.
Rosand  J , Muzikansky  A , Kumar  A ,  et al.  Spatial clustering of hemorrhages in probable cerebral amyloid angiopathy.   Ann Neurol. 2005;58(3):459-462. doi:10.1002/ana.20596 PubMedGoogle ScholarCrossref
59.
Banerjee  G , Carare  R , Cordonnier  C ,  et al.  The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice.   J Neurol Neurosurg Psychiatry. 2017;88(11):982-994. doi:10.1136/jnnp-2016-314697 PubMedGoogle ScholarCrossref
60.
Kleindorfer  DO , Towfighi  A , Chaturvedi  S ,  et al.  2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association.   Stroke. 2021;52(7):e364-e467. doi:10.1161/STR.0000000000000375 PubMedGoogle ScholarCrossref
61.
Fonseca  AC , Merwick  Á , Dennis  M ,  et al.  European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack.   Eur Stroke J. 2021;6(2):CLXIII-CLXXXVI. doi:10.1177/2396987321992905 PubMedGoogle ScholarCrossref
62.
Raposo  N , Charidimou  A , Roongpiboonsopit  D ,  et al.  Convexity subarachnoid hemorrhage in lobar intracerebral hemorrhage: a prognostic marker.   Neurology. 2020;94(9):e968-e977. doi:10.1212/WNL.0000000000009036 PubMedGoogle ScholarCrossref
63.
Charidimou  A , Boulouis  G , Gurol  ME ,  et al.  Emerging concepts in sporadic cerebral amyloid angiopathy.   Brain. 2017;140(7):1829-1850. doi:10.1093/brain/awx047 PubMedGoogle ScholarCrossref
64.
Wollenweber  FA , Opherk  C , Zedde  M ,  et al.  Prognostic relevance of cortical superficial siderosis in cerebral amyloid angiopathy.   Neurology. 2019;92(8):e792-e801. doi:10.1212/WNL.0000000000006956 PubMedGoogle ScholarCrossref
65.
Reijmer  YD , van Veluw  SJ , Greenberg  SM .  Ischemic brain injury in cerebral amyloid angiopathy.   J Cereb Blood Flow Metab. 2016;36(1):40-54. doi:10.1038/jcbfm.2015.88 PubMedGoogle ScholarCrossref
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