Cortical superficial siderosis: –how it effects the risk of recurrence of hemorragic stroke with cerebral amyloid angiopathy

In a YouTube interview on Mar 6, 2023, Dr Andreas Charidimou discussed the significance of cortical superficial siderosis (cSS) for predicting the risk of recurrence of a hemorrhagic stroke in patients with cerebral amyloid angiopathy. Here is a link to the video:
Note: The comments most relevant to this blog are at 20:05.

According to Dr. Charidimou, the risk of hemorrhagic stroke recurrence per year is normally about 7 to 10%. However, the presence — or absence — of cortical superficial siderosis [cSS] can signficantly alter these possibilities:

  • In the absence of cortical superficial siderosis, the risk may be as low as 5% per year.
  • With siderosis, the risk goes up to 10%
  • With multiple areas of siderosis the risk can go up to 20% per year (even though this is not common).

This interview, which is based on Dr. Charidimou’s research, is especially important because patients are interested not only in whether of not they have cerebral amyloid angiopathy (which will often be determined by a neurologist according to one of the versions of the Boston Criteria) but they will also want to know their chances for avoiding a recurrence.

Related research: Here is link to some related research by Dr. Andreas Charidimou and colleagues:

It was published in Neurology. 2017 Apr 25; 88(17): 1607–1614. “Cortical superficial siderosis and first-ever cerebral hemorrhage in cerebral amyloid angiopathy”

On particular interest is the following quotation “A subsequent imaging study found cSS in 40% of patients with probable CAA with lobar ICH and fewer than 5% of patients with a strictly deep pattern of ICH, typically denoting non-CAA “hypertensive” hemorrhages.

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