scholarly journals Computed tomography-negative symptomatic intracerebral hemorrhage in a patient with cerebral small vessel disease

Medicine ◽  
2020 ◽  
Vol 99 (29) ◽  
pp. e21382
Author(s):  
Jinhee Han ◽  
Harin Yang ◽  
Jeong Hoon Bae ◽  
Hyun Young Kim ◽  
Young Seo Kim
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease ◽  
Symptomatic Intracerebral Hemorrhage

scholarly journals Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage

Neurology ◽  
2021 ◽  
Vol 96 (15) ◽  
pp. e1954-e1965
Author(s):  
Isabel C. Hostettler ◽  
Ghil Schwarz ◽  
Gareth Ambler ◽  
Duncan Wilson ◽  
Gargi Banerjee ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Small Vessel Disease ◽  
Characteristic Curve ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Cortical Atrophy ◽  
Vessel Disease ◽  
Lemeshow Test ◽  
Ich Score

ObjectiveTo determine whether CT-based cerebral small vessel disease (SVD) biomarkers are associated with 6-month functional outcome after intracerebral hemorrhage (ICH) and whether these biomarkers improve the performance of the preexisting ICH prediction score.MethodsWe included 864 patients with acute ICH from a multicenter, hospital-based prospective cohort study. We evaluated CT-based SVD biomarkers (white matter hypodensities [WMH], lacunes, brain atrophy, and a composite SVD burden score) and their associations with poor 6-month functional outcome (modified Rankin Scale score >2). The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow test were used to assess discrimination and calibration of the ICH score with and without SVD biomarkers.ResultsIn multivariable models (adjusted for ICH score components), WMH presence (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.12–2.06), cortical atrophy presence (OR 1.80, 95% CI 1.19–2.73), deep atrophy presence (OR 1.66, 95% CI 1.17–2.34), and severe atrophy (either deep or cortical) (OR 1.94, 95% CI 1.36–2.74) were independently associated with poor functional outcome. For the revised ICH score, the AUROC was 0.71 (95% CI 0.68–0.74). Adding SVD markers did not significantly improve ICH score discrimination; for the best model (adding severe atrophy), the AUROC was 0.73 (95% CI 0.69–0.76). These results were confirmed when lobar and nonlobar ICH were considered separately.ConclusionsThe ICH score has acceptable discrimination for predicting 6-month functional outcome after ICH. CT biomarkers of SVD are associated with functional outcome, but adding them does not significantly improve ICH score discrimination.Trial Registration InformationClinicalTrials.gov Identifier: NCT02513316.

Contribution of Racial and Ethnic Differences in Cerebral Small Vessel Disease Subtype and Burden to Risk of Cerebral Hemorrhage Recurrence

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011932
Author(s):  
Juan Pablo Castello ◽  
Marco Pasi ◽  
Jessica R Abramson ◽  
Axana Rodriguez-Torres ◽  
Sandro Marini ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ethnic Differences ◽  
Small Vessel Disease ◽  
Ethnic Disparities ◽  
Recurrence Risk ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Amyloid Angiopathy ◽  
Vessel Disease ◽  
Racial Ethnic

Objective:Black and Hispanic survivors of Intracerebral Hemorrhage (ICH) are at higher risk of recurrent intracranial bleeding. MRI-based markers of chronic Cerebral Small Vessel Disease (CSVD) are consistently associated with recurrent ICH. We therefore sought to investigate whether racial/ethnic differences in MRI-defined CSVD subtype and severity contribute to disparities in ICH recurrence risk.Methods:We analyzed data from the Massachusetts General Hospital ICH study (MGH-ICH, n=593) and the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study (n= 329). Using CSVD markers derived from MRIs obtained within 90 days of index ICH, we classified ICH cases as cerebral amyloid angiopathy (CAA)-related, hypertensive arteriopathy (HTNA)-related, and mixed etiology. We quantified CSVD burden using validated global, CAA-specific, and HTNA-specific scores. We compared CSVD subtype and severity among White, Black, and Hispanic ICH survivors and investigated its association with ICH recurrence risk.Results:We analyzed data for 922 ICH survivors (655 White, 130 Black, 137 Hispanic). Minority ICH survivors had greater global CSVD (p=0.011) and HTNA burden (p=0.021) on MRI. Furthermore, minority survivors of HTNA-related and mixed etiology ICH demonstrated higher HTNA burden, resulting in increased ICH recurrence risk (all p < 0.05).Conclusions:We uncovered significant differences in CSVD subtypes and severity among White and minority survivors of primary ICH, with direct implication for known disparities in ICH recurrence risk. Future studies of racial / ethnic disparities in ICH outcomes will benefit from including detailed MRI-based assessment of CSVD subtypes and severity, and investigating social determinants of health.

scholarly journals Association of cerebral small vessel disease and cognitive decline after intracerebral hemorrhage

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011050
Author(s):  
Marco Pasi ◽  
Lansing Sugita ◽  
Li Xiong ◽  
Andreas Charidimou ◽  
Gregoire Boulouis ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Dementia Diagnosis ◽  
Vessel Disease ◽  
Ct Data ◽  
New Onset

Objective:We sought to determine whether MRI-based Cerebral Small Vessel Disease (CSVD) burden assessment, in addition to clinical and CT data, improved prediction of cognitive impairment after spontaneous Intracerebral Hemorrhage (ICH).Methods:We analyzed data from ICH survivors enrolled in a single-center prospective study. We employed three validated CSVD burden scores: global, cerebral amyloid angiopathy (CAA)-specific, hypertensive arteriopathy (HTNA)-specific. We quantified cognitive performance by administering the modified Telephone Interview for Cognitive Status (TICS-m) test. We utilized linear mixed models to model cognitive decline rates, and survival models for new-onset dementia. We calculated CSVD scores’ cut-offs to maximize predictive performance for dementia diagnosis.Results:We enrolled 612 ICH survivors, and followed them for a median of 46.3 months (Inter-Quartile Range: 35.5-58.7). A total of 214/612 (35%) participants developed dementia. Higher global CSVD scores at baseline were associated with faster cognitive decline (Coeff -0.25, Standard Error [SE] 0.02) and dementia risk (Sub-Hazard Ratio 1.35, 95% CI 1.10-1.65). The global score outperformed the CAA and HTNA scores in predicting post-ICH dementia (all p<0.05). Compared to a model including readily available clinical and CT data, inclusion of the global CSVD score resulted in improved prediction of post-ICH dementia (Area Under the Curve [AUC] 0.89, SE 0.02 vs. AUC 0.81, SE 0.03, p = 0.008 for comparison). Global CSVD scores ≥ 2 had highest sensitivity (83%) and specificity (91%) for dementia diagnosis.Conclusions:A validated MRI-based CSVD score is associated with cognitive performance after ICH, and improved diagnostic accuracy for predicting new onset of dementia.

scholarly journals Differences in cerebral small vessel disease magnetic resonance imaging markers between lacunar stroke and non–Lobar intracerebral hemorrhage

2021 ◽  
pp. 239698732110317
Author(s):  
Kim Wiegertjes ◽  
Michelle G Jansen ◽  
Wilmar MT Jolink ◽  
Marco Duering ◽  
Emma A Koemans ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Multivariable Logistic Regression Analysis ◽  
Lacunar Stroke ◽  
Vessel Disease ◽  
Different Types ◽  
Imaging Markers ◽  
Lesion Symptom Mapping

Introduction It is unclear why cerebral small vessel disease (SVD) leads to lacunar stroke in some and to non–lobar intracerebral hemorrhage (ICH) in others. We investigated differences in MRI markers of SVD in patients with lacunar stroke or non–lobar ICH. Patients and methods We included patients from two prospective cohort studies with either lacunar stroke (RUN DMC) or non–lobar ICH (FETCH). Differences in SVD markers (white matter hyperintensities [WMH], lacunes, cerebral microbleeds [CMB]) between groups were investigated with univariable tests; multivariable logistic regression analysis, adjusted for age, sex, and vascular risk factors; spatial correlation analysis and voxel–wise lesion symptom mapping. Results We included 82 patients with lacunar stroke (median age 63, IQR 57–72) and 54 with non-lobar ICH (66, 59–75). WMH volumes and distribution were not different between groups. Lacunes were more frequent in patients with a lacunar stroke (44% vs. 17%, adjusted odds ratio [aOR] 5.69, 95% CI [1.66–22.75]) compared to patients with a non–lobar ICH. CMB were more frequent in patients with a non–lobar ICH (71% vs. 23%, aOR for lacunar stroke vs non–lobar ICH 0.08 95% CI [0.02–0.26]), and more often located in non–lobar regions compared to CMB in lacunar stroke. Discussion Although we obserd different types of MRI markers of SVD within the same patient, ischemic markers of SVD were more frequent in the ischemic type of lacunar stroke, and hemorrhagic markers were more prevalent in the hemorrhagic phenotype of non-lobar ICH. Conclusion There are differences between MRI markers of SVD between patients with a lacunar stroke and those with a non-lobar ICH.

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