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.

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

Stroke ◽  
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

Decreased hemoglobin levels, cerebral small-vessel disease, and cortical atrophy: among cognitively normal elderly women and men

2015 ◽  
Vol 28 (1) ◽  
pp. 147-156 ◽  
Author(s):  
Sang Eon Park ◽  
Hojeong Kim ◽  
Jeongmin Lee ◽  
Na Kyung Lee ◽  
Jung Won Hwang ◽  
...  
Keyword(s):  
Cortical Thickness ◽  
Elderly Women ◽  
Small Vessel Disease ◽  
The Elderly ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Cortical Atrophy ◽  
Cognitively Normal ◽  
Vessel Disease ◽  
Age Related

ABSTRACTBackground:Decreased hemoglobin levels increase the risk of developing dementia among the elderly. However, the underlying mechanisms that link decreased hemoglobin levels to incident dementia still remain unclear, possibly due to the fact that few studies have reported on the relationship between low hemoglobin levels and neuroimaging markers. We, therefore, investigated the relationships between decreased hemoglobin levels, cerebral small-vessel disease (CSVD), and cortical atrophy in cognitively healthy women and men.Methods:Cognitively normal women (n = 1,022) and men (n = 1,018) who underwent medical check-ups and magnetic resonance imaging (MRI) were enrolled at a health promotion center. We measured hemoglobin levels, white matter hyperintensities (WMH) scales, lacunes, and microbleeds. Cortical thickness was automatically measured using surface based methods. Multivariate regression analyses were performed after controlling for possible confounders.Results:Decreased hemoglobin levels were not associated with the presence of WMH, lacunes, or microbleeds in women and men. Among women, decreased hemoglobin levels were associated with decreased cortical thickness in the frontal (Estimates, 95% confidence interval, −0.007, (−0.013, −0.001)), temporal (−0.010, (−0.018, −0.002)), parietal (−0.009, (−0.015, −0.003)), and occipital regions (−0.011, (−0.019, −0.003)). Among men, however, no associations were observed between hemoglobin levels and cortical thickness.Conclusion:Our findings suggested that decreased hemoglobin levels affected cortical atrophy, but not increased CSVD, among women, although the association is modest. Given the paucity of modifiable risk factors for age-related cognitive decline, our results have important public health implications.

scholarly journals Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease

2016 ◽  
Vol 87 (12) ◽  
pp. 1296-1302 ◽  
Author(s):  
Hanna Jokinen ◽  
Susanna Melkas ◽  
Sofia Madureira ◽  
Ana Verdelho ◽  
José M Ferro ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Cognitive Reserve ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease

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.

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