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Cerebral small vessel disease burden and functional and radiographic outcomes in intracerebral hemorrhage

Abstract

Objective

To examine the effect of individual cerebral small vessel disease (CSVD) markers and cumulative CSVD burden on functional independence, ambulation and hematoma expansion in spontaneous intracerebral hemorrhage (ICH).

Methods

Retrospective analysis of prospectively collected data from an observational study of consecutive patients with spontaneous ICH, brain MRI within 1 month from ictus, premorbid modified Rankin Scale (mRS) score ≤ 2, available imaging data and 90-day functional status in a tertiary academic center. Functional outcomes included 90-day functional independence (mRS ≤ 2) and independent ambulation; radiographic outcome was hematoma expansion (> 12.5 ml absolute or > 33% relative increase in ICH volume). We identified the presence and burden of individual CSVD markers (cerebral microbleeds (CMBs), enlarged perivascular spaces, lacunes, white matter hyperintensities) and composite CSVD burden score and explored their association with outcomes of interest in multivariable models adjusting for well-established confounders.

Results

111 patients were included, 65% lobar ICH, with a median volume 20.8 ml. 43 (38.7%) achieved functional independence and 71 (64%) independent ambulation. In multivariable adjusted models, there was higher total CSVD burden (OR 0.61, 95% CI 0.37–0.96, p = 0.03) and CMBs presence (OR 0.32, 95% CI 0.1–0.88, p = 0.04) remained independently inversely associated with functional independence. Individual CSVD markers or total CSVD score had no significant relation with ambulation and ICH expansion. Larger ICH volume and deep ICH location were the major determinants of lack of independent ambulation.

Conclusions

Our findings suggest that in ICH patients without previous functional dependence, total CSVD burden and particularly presence of CMBs significantly affect functional recovery. The latter is a novel finding and merits further exploration.

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Fig. 1

Abbreviations

ICH:

Intracerebral hemorrhage

IVH:

Intraventricular hemorrhage

CSVD:

Cerebral small vessel disease

WMH:

White matter hyperintensities

EPVS:

Enlarged perivascular spaces

CMB:

Cerebral microbleeds

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Acknowledgements

Dr. Lioutas had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Statistical analysis was performed by Dr. Lioutas (Beth Israel Deaconess Medical Center, Harvard Medical School).

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

V-AL: design and conceptualization of the study, data collection, analysis and interpretation of the data, drafting of original manuscript. BW: data collection, revision of the manuscript for intellectual content. CN: data collection, revision of the manuscript for intellectual content. JH: data collection, revision of the manuscript for intellectual content. JM: revision of the manuscript for intellectual content. MS: analysis and interpretation of the data, revision of the manuscript for intellectual content.

Corresponding author

Correspondence to Vasileios-Arsenios Lioutas.

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Conflicts of interest

None of the authors reports any disclosures.

Ethical standard

The study was approved by the Institutional Review Board of Beth Israel Deaconess Medical Center without need for informed consent.

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Lioutas, VA., Wu, B., Norton, C. et al. Cerebral small vessel disease burden and functional and radiographic outcomes in intracerebral hemorrhage. J Neurol 265, 2803–2814 (2018). https://doi.org/10.1007/s00415-018-9059-5

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  • DOI: https://doi.org/10.1007/s00415-018-9059-5

Keywords

  • Intracerebral hemorrhage
  • Cerebral small vessel disease
  • Small vessel disease
  • Functional recovery
  • Cerebral microbleeds