Introduction: Cortical superficial siderosis (CSS) is a neuroimaging biomarker of interest in intracerebral hemorrhage (ICH) and represents hemosiderin deposition in the supratentorial sulci. CSS increases risk for recurrent ICH and is associated with cognitive impairment, but the long-term outcomes of ICH patients with CSS are unknown. We sought to characterize the long-term case-fatality of ICH patients with CSS.
Methods: We performed a retrospective convenience study of primary ICH patients who underwent MRI during the index admission. We evaluated each hemisphere for presence of CSS, as well as other SVD markers, and performed Kaplan-Meier analysis to compare the survival curves of those with and without CSS. Vital status was ascertained via chart review and a National Death Index query when necessary.
Results: Of 121 patients who underwent an MRI in our cohort, 95 had usable GRE or SWI sequences. Overall CSS prevalence was 11.6% (11/95): 18.2% (10/55) in lobar ICH and 2.5% (1/40) in deep ICH. Univariate predictors of CSS presence included older age (75.6 vs. 63.8, p=.01), larger hematoma volume (10.5mL vs. 4.6, p=.02), and prior ICH (54.5% vs. 10.7%, p=.002). There were no differences between the groups in MBs, EPVS, WMD scores, or DWI lesions. Patients with CSS had a significantly different survival history than those without CSS (log-rank p=.034). Twenty-five percent of the patients with CSS died by 4.4 months after index admission, compared with 45.1 months for those without CSS. The risk of death for the patients with CSS was 2.6 times (95% CI: 1.06-6.41) higher than those without. Four of 11 (36.4%) CSS patients lived at least 4 years after index ICH.
Conclusions: Characterization of CSS in ICH patients may improve disease subtyping and clinical trial design. Future studies with larger and more generalizable cohorts are needed to assess how CSS focality vs. dissemination affects case-fatality and whether CSS is an independent predictor of case-fatality.