Commentary on Associations of Radiographic Small Vessel Disease with Acute Intracerebral Hemorrhage Volume, Hematoma Expansion, and Intraventricular Hemorrhage

Abstract Background and Objective The aim of this study was to evaluate the impact of radiographic cerebral small vessel disease (CSVD) on the severity of acute intracerebral hemorrhage (ICH) as measured by: ICH volume, hematoma expansion, and extension of intraventricular hemorrhage (IVH). Methods CSVD was determined on baseline computed tomography (CT) scans of patients from the Ethnic and Racial Variations of Intracerebral Hemorrhage study through the extent of leukoaraiosis and cerebral atrophy using visual rating scales. The associations of leukoaraiosis and atrophy with ICH volume, hematoma expansion, IVH presence, and severity of IVH were tested using multivariable regression models. Secondary analyses were stratified by hemorrhage location. Bonferroni correction was applied to correct for multiple testing. Results A total of 2579 patients (mean age 61.7 years, 59% male) met inclusion criteria. Median ICH volume was 10.5 (Interquartile range [IQR] 4.0–25.3) mL. IVH was detected in 971 patients (38%). Neither leukoaraiosis nor atrophy was associated with hematoma expansion. Increasing grades of leukoaraiosis were associated with increased risk of IVH in a dose-dependent manner, while cerebral atrophy was inversely associated with IVH (both P for trend < 0.001). Increasing grades of global atrophy were dose-dependently associated with lower ICH volumes (ß (95% Confidence Interval [CI]) − 0.30[− 0.46, − 0.14], − 0.33[− 0.49, − 0.17], − 0.40[− 0.60, − 0.20], and − 0.54[− 0.76, − 0.32], for grades 1, 2, 3 and 4 compared to 0; all P < 0.001). The associations of leukoaraiosis with ICH volume were consistent with those of atrophy, albeit not meeting statistical significance. Conclusions Leukoaraiosis and cerebral atrophy appear to have opposing associations with ICH severity. Cerebral atrophy correlates with smaller ICH volume and decreased risk and severity of IVH, while leukoaraiosis is associated with increased risk of IVH. Whether these observations reflect overlapping or divergent underlying mechanisms requires further study.

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Do imaging markers of cerebral small vessel disease predict hematoma volume and outcome in acute intracerebral hemorrhage?

Annals of Indian Academy of Neurology ◽

10.4103/aian.aian_183_20 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Rohit Bhatia ◽

AnandR Warrier ◽

Ajay Garg ◽

MV Padma Srivastava ◽

Deepa Dash ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Hematoma Volume ◽

Vessel Disease ◽

Acute Intracerebral Hemorrhage ◽

Imaging Markers

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Total small vessel disease score and functional outcomes following acute intracerebral hemorrhage

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.105001 ◽

2020 ◽

Vol 29 (8) ◽

pp. 105001

Author(s):

Yoko Kimura ◽

Kaori Miwa ◽

Junji Takasugi ◽

Naoki Oyama ◽

Kenichi Todo ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcomes ◽

Small Vessel Disease ◽

Small Vessel ◽

Disease Score ◽

Vessel Disease ◽

Acute Intracerebral Hemorrhage

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Abstract WP336: Cerebral Small Vessel Disease Burden, Functional Outcome and Hematoma Expansion in Intracerebral Hemorrhage

Stroke ◽

10.1161/str.49.suppl_1.wp336 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Vasileios-Arsenios Lioutas ◽

Bo Wu ◽

Johanna Helenius ◽

Janhavi Modak ◽

Casey Norton ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Disease Burden ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Hematoma Expansion ◽

Vessel Disease

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Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.115.012147 ◽

2016 ◽

Vol 47 (3) ◽

pp. 701-707 ◽

Cited By ~ 29

Author(s):

Shoichiro Sato ◽

Candice Delcourt ◽

Emma Heeley ◽

Hisatomi Arima ◽

Shihong Zhang ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Vessel Disease ◽

Acute Intracerebral Hemorrhage

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Cerebral Microbleeds and Acute Hematoma Characteristics in the ATACH-2 and MISTIE III Trials

Neurology ◽

10.1212/wnl.0000000000013247 ◽

2021 ◽

pp. 10.1212/WNL.0000000000013247

Author(s):

Jessica R Magid-Bernstein ◽

Yunke Li ◽

Sung-Min Cho ◽

Pirouz J. Piran ◽

David J. Roh ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Fixed Effects ◽

Small Vessel Disease ◽

Prognostic Significance ◽

Cerebral Microbleeds ◽

Small Vessel ◽

Hematoma Expansion ◽

Study Cohort ◽

Vessel Disease ◽

The Relationship

Background and Objectives:To study the relationship between the presence of cerebral microbleeds (CMBs) and acute hematoma characteristics among patients with primary intracerebral hemorrhage (ICH).Methods:We pooled individual patient data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-2) trial and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation phase 3 trial (MISTIE III). We included subjects with a brain magnetic resonance imaging (MRI) scan. Exposure was the presence of a CMB. The co-primary outcomes were admission ICH volume and hematoma expansion. Mixed-effects linear and logistic regression models were used, with demographics and comorbidities considered fixed effects, and the study cohort treated as a random effect. Additional analyses assessed the relationship between CMB topography and number, and hematoma characteristics.Results:Of the 1,499 ICH patients enrolled in the parent trials, 466 (31.1%) were included in this analysis, and 231 (49.6%) patients had CMBs. In adjusted models, presence of CMBs was associated with smaller ICH volume (Beta, -0.26; 95% CI, -0.44 to -0.08), and lower odds of hematoma expansion (OR, 0.65; 95% CI 0.40-0.95; P=0.04). The strength of association between CMBs and hematoma characteristics increased with increasing number of CMBs. The location of the CMBs and the severity of leukoaraiosis did not modify these results.Discussion:In a pooled cohort of ICH patients, our results are consistent with the hypothesis that more severe underlying small vessel disease, as represented by CMBs, leads to smaller baseline hematoma volumes and reduced hematoma expansion. Underlying cerebral small vessel disease may be of prognostic significance after ICH.Classification of Evidence:This study provides Class II evidence that the presence of microbleeds on MRI is associated with a smaller ICH volume at presentation and a lower rate of hematoma expansion on follow-up imaging.

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