Abstract 2590: Supratentorial Superficial Siderosis is a Warning Sign of Subsequent Intracerebral Hemorrhage

Background: Non-traumatic supratentorial superficial siderosis (SupSid) is a putative MRI-marker for cerebral amyloid angiopathy (CAA). Case reports have suggested that SupSid might be a predictor for subsequent intracranial hemorrhage in these patients. However, systematic studies on its prognostic significance are missing. Methods: We retrospectively analysed patients with SupSid most probably due to CAA. Patients were identified by a systematic database search at our institution (years 2000-2010). Additional inclusion criteria were clinical or imaging follow-up (MRI or CT, minimum 6 months) and at least one angiographic modality to exclude intracranial vascular malformations. Exclusion criteria were infratentorial siderosis, poor image quality, presence of an aneurysm or history of aneurysmal subarachnoid haemorrhage (SAH), head trauma, head or spine surgery, and SupSid due to known other causes than CAA. Results: A total of 51 patients met the inclusion criteria (35 males, mean age at t0 = 72.8 ± 7.2 years, range: 50 to 86 years). The median clinical follow-up time was 88.2 months (range: 6 to 292.5 months). Additional imaging follow-up was available in 33 patients (median imaging follow-up time: 36.2 months; range: 0.3 to 283 months). A total of 18 (35.3 %) patients developed intracerebral hemorrhage (ICH) during follow up. Among those, the majority (13) was located at the site of initial siderosis and 5 were situated elsewhere (p Conclusions: Patients with SupSid are at high risk for subsequent ICH or SAH. SupSid can be considered a warning sign of subsequent ICH at its location. Prospective studies are needed to confirm and further evaluate these findings.