Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Boston University School of Medicine, Boston, MA, USA.
Int J Stroke. 2021 Oct;16(7):798-808. doi: 10.1177/1747493020984559. Epub 2021 Jan 21.
We aimed to characterize cortical superficial siderosis, its determinants and sequel, in community-dwelling older adults.
The sample consisted of Framingham ( = 1724; 2000-2009) and Rotterdam ( = 4325; 2005-2013) study participants who underwent brain MRI. In pooled individual-level analysis, we compared baseline characteristics in patients with cortical superficial siderosis to two reference groups: (i) persons without hemorrhagic MRI markers of cerebral amyloid angiopathy (no cortical superficial siderosis and no microbleeds) and (ii) those with presumed cerebral amyloid angiopathy based on the presence of strictly lobar microbleeds but without cortical superficial siderosis.
Among a total of 6049 participants, 4846 did not have any microbleeds or cortical superficial siderosis (80%), 401 had deep/mixed microbleeds (6.6%), 776 had strictly lobar microbleeds without cortical superficial siderosis (12.8%) and 26 had cortical superficial siderosis with/without microbleeds (0.43%). In comparison to participants without microbleeds or cortical superficial siderosis and to those with strictly lobar microbleeds but without cortical superficial siderosis, participants with cortical superficial siderosis were older (OR 1.09 per year, 95% CI 1.05, 1.14; < 0.001 and 1.04, 95% CI 1.00, 1.09; = 0.058, respectively), had overrepresentation of the APOE ɛ4 allele (5.19, 2.04, 13.25; = 0.001 and 3.47, 1.35, 8.92; = 0.01), and greater prevalence of intracerebral hemorrhage (72.57, 9.12, 577.49; < 0.001 and 81.49, 3.40, >999.99; = 0.006). During a mean follow-up of 5.6 years, 42.4% participants with cortical superficial siderosis had a stroke (five intracerebral hemorrhage, two ischemic strokes and four undetermined strokes), 19.2% had transient neurological deficits and 3.8% developed incident dementia.
Our study adds supporting evidence to the association between cortical superficial siderosis and cerebral amyloid angiopathy within the general population. Community-dwelling persons with cortical superficial siderosis may be at high risk for intracerebral hemorrhage and future neurological events.
本研究旨在描述社区居住的老年人皮质下脑铁沉积的特征、其决定因素和后果。
本研究纳入了弗雷明汉（ = 1724；2000-2009 年）和鹿特丹（ = 4325；2005-2013 年）研究的参与者，他们均接受了脑部 MRI 检查。在汇总的个体水平分析中，我们将皮质下脑铁沉积患者的基线特征与两个参考组进行了比较：（i）无脑内淀粉样血管病出血 MRI 标志物的患者（无皮质下脑铁沉积且无微出血）和（ii）基于单纯性脑叶微出血但无脑皮质下脑铁沉积而被认为患有脑淀粉样血管病的患者。
在总共 6049 名参与者中，4846 名（80%）没有任何微出血或皮质下脑铁沉积，401 名（6.6%）有深部/混合性微出血，776 名（12.8%）有单纯性脑叶微出血而无脑皮质下脑铁沉积，26 名（0.43%）有皮质下脑铁沉积伴/不伴微出血。与无脑内微出血或皮质下脑铁沉积的患者以及无脑皮质下脑铁沉积但无脑叶微出血的患者相比，皮质下脑铁沉积患者年龄更大（每年增加 1.09，95%CI 1.05，1.14； < 0.001 和每年增加 1.04，95%CI 1.00，1.09； = 0.058），载脂蛋白 E4 等位基因（APOE ɛ4）的占有率更高（5.19，2.04，13.25； = 0.001 和 3.47，1.35，8.92； = 0.01），颅内出血的患病率更高（72.57，9.12，577.49； < 0.001 和 81.49，3.40，>999.99； = 0.006）。在平均 5.6 年的随访期间，42.4%的皮质下脑铁沉积患者发生了卒中（5 例为颅内出血，2 例为缺血性卒中，4 例为未明确类型的卒中），19.2%发生了短暂性神经功能缺损，3.8%发展为新发痴呆。
本研究为皮质下脑铁沉积与一般人群中的脑淀粉样血管病之间的关联提供了更多的证据。有皮质下脑铁沉积的社区居住者可能有较高的颅内出血和未来发生神经事件的风险。
