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Cerebral small vessel disease in patients with spontaneous cerebellar hemorrhage

  • Marco PasiEmail author
  • Andreas Charidimou
  • Gregoire Boulouis
  • Panagiotis Fotiadis
  • Andrea Morotti
  • Li Xiong
  • Sandro Marini
  • Alison Ayres
  • Matthew P. Frosch
  • Joshua N. Goldstein
  • Jonathan Rosand
  • M. Edip Gurol
  • Steven M. Greenberg
  • Anand Viswanathan
Original Communication
  • 66 Downloads

Abstract

Background

Spontaneous cerebellar-intracerebral hemorrhage (ICH) can be associated with both cerebral amyloid angiopathy (CAA) and hypertensive small vessel disease (HTN-SVD, i.e. arteriolosclerosis). To better understand the underlying microangiopathy of cerebellar-ICH, we aimed to evaluate the spatial distribution of supratentorial cerebral microbleeds (CMBs) and neuropathologic profiles in these patients.

Methods

We enrolled consecutive cerebellar-ICH patients. Clinical variables and MRI markers specific for CAA and HTN-SVD were assessed. Patients were classified into categories according to the topography (strictly-lobar, strictly-deep, and mixed) of supratentorial CMBs and comparisons were performed. Available neuropathological material was reviewed to evaluate the presence and severity of arteriolosclerosis and CAA.

Results

Ninety-eight cerebellar-ICH patients were enrolled. Fifty patients (51%) had at least one supratentorial CMB. Twelve patients (12%) had strictly lobar-CMBs, 12 patients (12%) showed strictly deep-CMBs and mixed-CMBs (lobar and deep CMBs) were present in 26 cerebellar-ICH patients (27%). In multivariable analysis, cerebellar-ICH patients with mixed-CMBs were associated with higher prevalence of hypertension (OR 4.9, 95% confidence interval [CI] 1.2–20, p = 0.017) but with lower prevalence of severe centrum-semiovale enlarged perivascular spaces (OR 0.2, CI 0.05–0.8, p = 0.024) when compared to cerebellar-ICH patients with strictly lobar-CMBs. Vascular risk factors and neuroimaging characteristics were similar between strictly deep-CMBs and mixed-CMBs. Six patients had available neuropathological material for analyses and they all showed some degree of arteriolosclerosis.

Conclusions

Cerebellar-ICH patients frequently show supratentorial CMBs. The mixed-CMBs pattern appears to be the most common. Our radiological and pathological results suggest that the majority of cerebellar-ICH patients harbor HTN-SVD as dominant microangiopathy.

Keywords

Cerebellar-ICH Microbleeds Small vessel disease 

Notes

Funding

NIH Grants R01AG047975, R01AG026484, P50AG005134, K23AG02872605.

Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflict of interest.

Supplementary material

415_2018_9177_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Marco Pasi
    • 1
    Email author
  • Andreas Charidimou
    • 1
  • Gregoire Boulouis
    • 2
  • Panagiotis Fotiadis
    • 1
  • Andrea Morotti
    • 1
  • Li Xiong
    • 1
  • Sandro Marini
    • 1
  • Alison Ayres
    • 1
  • Matthew P. Frosch
    • 3
  • Joshua N. Goldstein
    • 4
  • Jonathan Rosand
    • 4
  • M. Edip Gurol
    • 1
  • Steven M. Greenberg
    • 1
  • Anand Viswanathan
    • 1
  1. 1.Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research CenterHarvard Medical SchoolBostonUSA
  2. 2.Department of Neuroradiology, Centre Hospitalier Sainte-AnneUniversité Paris-Descartes, INSERM UMR 894ParisFrance
  3. 3.C.S. Kubik Laboratory for Neuropathology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  4. 4.Division of Neurocritical Care and Emergency Neurology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

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