Convexity subarachnoid hemorrhage in ischemic stroke.

OBJECTIVE: To report three cases of convexity subarachnoid hemorrhage (cSAH) after acute ischemic stroke and review the relevant literature.

BACKGROUND: cSAH is an unusual presentation and the association with acute ischemic stroke has only infrequently been reported.

DESIGN AND METHODS: Case series with retrospective review of the clinical presentation and neuroimaging features of patients who presented with cSAH and acute ischemic stroke.

RESULTS: We describe three cases of cSAH who presented with ipsilateral acute ischemic stroke. Two patients had ipsilateral ICA stenosis, with one patient developing cSAH after ICA stenting. The third patient developed cSAH in setting of small distal cortical ischemic lesions with normal cranial vasculature. None of these patients had evidence for cerebral amyloid angiopathy on magnetic resonance imaging-gradient echo (MRI-GRE) sequence. All our patients remained clinically stable with limited neurological deficit at the time of discharge.

CONCLUSION: We report three more cases linking cSAH with ischemic strokes. All of our patients had good outcome with minimal neurological deficit. cSAH should remain in differential diagnosis and early complication of acute ischemic stroke.