Abstract Details

Title Illustration of exacerbating cortical superficial siderosis on close-up MRIs after resumption of anticoagulant therapy.

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P15 - Poster Session 15 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-009

Background We report the case of a 71-year-old patient, with atrial fibrillation (AF) under anticoagulant treatment and hypertension controlled to target guidelines, admitted in 2009 for a right frontal-parietal lobar hematoma. In this context, the anticoagulant treatment was stopped. Initial MRI showed no signs of small vessel disease but follow-up imaging at one year showed cSS around the initial lesion.

Objective Cortical superficial siderosis (cSS) is an MRI marker of cerebral amyloid angiopathy, which has a poorly understood evolutionary profile and could be aggravated by various factors, in particular hypertension and anticoagulation.

Design/Methods Between 2010 and 2017, the patient was lost to follow-up. In 2017, he sought for medical attention because of progressive cognitive impairment. The MRI revealed a progression of the cSS. Because of permanent AF, left atrial appendage closure (LAAC) was planned. The pre-LAAC cardiac CT scan showed intra cardiac thrombus, warranting anticoagulant treatment with apixaban 5mgx2 for 2 months.

Results

After LAAC, anticoagulant treatment continued by his cardiologist with rivaroxaban 15 mg/day. Three months after LAAC, cardiac CT fortuitously showed bilateral pulmonary embolism, motivating the continuation of anticoagulation with rivaroxaban 20 mg for 6 months. During this period, a monthly brain MRI was performed to monitor the evolution of the cSS. These MRIs showed a progressive exacerbation of the cSS, becoming extensive and bilateral, at each check-up, including after interruption of anticoagulant treatment. In early 2019, the patient was admitted to the hospital with a right frontal hematoma, with an unfavorable evolution leading to his death.

Conclusions

This case illustrates, through sequential imaging, the aggravation of cSS in the setting of probable CAA according to the Boston criteria. We discuss the link between the extension of this cSS and the resumption of anticoagulants, which would be a possible aggravating factor in this patient, who had otherwise, a perfectly controlled hypertension.

Authors/Disclosures
Bianca Oana Pîrlog, MD (County Emergency Hospital) PRESENTER	Dr. Pîrlog has nothing to disclose.
	No disclosure on file
Pierre Amarenco, MD	Dr. Amarenco has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AstraZeneca. Dr. Amarenco has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. Dr. Amarenco has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BMS. The institution of Dr. Amarenco has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Pfizer. Dr. Amarenco has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for KOWA company.
	No disclosure on file