1
|
Goeldlin M, Stewart C, Radojewski P, Wiest R, Seiffge D, Werring DJ. Clinical neuroimaging in intracerebral haemorrhage related to cerebral small vessel disease: contemporary practice and emerging concepts. Expert Rev Neurother 2022; 22:579-594. [PMID: 35850578 DOI: 10.1080/14737175.2022.2104157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION About 80% of all non-traumatic intracerebral haemorrhage (ICH) are caused by the sporadic cerebral small vessel diseases deep perforator arteriopathy (DPA, also termed hypertensive arteriopathy or arteriolosclerosis) and cerebral amyloid angiopathy (CAA), though these frequently co-exist in older people. Contemporary neuroimaging (MRI and CT) detects an increasing spectrum of haemorrhagic and non-haemorrhagic imaging biomarkers of small vessel disease which may identify the underlying arteriopathies. AREAS COVERED We discuss biomarkers for cerebral small vessel disease subtypes in ICH, and explore their implications for clinical practice and research. EXPERT OPINION ICH is not a single disease, but results from a defined range of vascular pathologies with important implications for prognosis and treatment. The terms "primary" and "hypertensive" ICH are poorly defined and should be avoided, as they encourage incomplete investigation and classification. Imaging-based criteria for CAA will show improved diagnostic accuracy, but specific imaging biomarkers of DPA are needed. Ultra-high-field 7T-MRI using structural and quantitative MRI may provide further insights into mechanisms and pathophysiology of small vessel disease. We expect neuroimaging biomarkers and classifications to allow personalized treatments (e.g. antithrombotic drugs) in clinical practice and to improve patient selection and monitoring in trials of targeted therapies directed at the underlying arteriopathies.
Collapse
Affiliation(s)
- Martina Goeldlin
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Catriona Stewart
- Stroke Research Group, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Piotr Radojewski
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - David J Werring
- Stroke Research Group, UCL Queen Square Institute of Neurology, London, United Kingdom
| |
Collapse
|
2
|
Jolink WMT, Wiegertjes K, Rinkel GJE, Algra A, de Leeuw FE, Klijn CJM. Location-specific risk factors for intracerebral hemorrhage: Systematic review and meta-analysis. Neurology 2020; 95:e1807-e1818. [PMID: 32690784 DOI: 10.1212/wnl.0000000000010418] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/10/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of studies reporting on risk factors according to location of the intracerebral hemorrhage. METHODS We searched PubMed and Embase for cohort and case-control studies reporting ≥100 patients with spontaneous intracerebral hemorrhage that specified the location of the hematoma and reported associations with risk factors published until June 27, 2019. Two authors independently extracted data on risk factors. Estimates were pooled with the generic variance-based random-effects method. RESULTS After screening 10,013 articles, we included 42 studies totaling 26,174 patients with intracerebral hemorrhage (9,141 lobar and 17,033 nonlobar). Risk factors for nonlobar intracerebral hemorrhage were hypertension (risk ratio [RR] 4.25, 95% confidence interval [CI] 3.05-5.91, I 2 = 92%), diabetes mellitus (RR 1.35, 95% CI 1.11-1.64, I 2 = 37%), male sex (RR 1.63, 95% CI 1.25-2.14, I 2 = 61%), alcohol overuse (RR 1.48, 95% CI 1.21-1.81, I 2 = 19%), underweight (RR 2.12, 95% CI 1.12-4.01, I 2 = 31%), and being a Black (RR 2.83, 95% CI 1.02-7.84, I 2 = 96%) or Hispanic (RR 2.95, 95% CI 1.69-5.14, I 2 = 71%) participant compared with being a White participant. Hypertension, but not any of the other risk factors, was also a risk factor for lobar intracerebral hemorrhage (RR 1.83, 95% CI 1.39-2.42, I 2 = 76%). Smoking, hypercholesterolemia, and obesity were associated with neither nonlobar nor lobar intracerebral hemorrhage. CONCLUSIONS Hypertension is a risk factor for both nonlobar and lobar intracerebral hemorrhage, although with double the effect for nonlobar intracerebral hemorrhage. Diabetes mellitus, male sex, alcohol overuse, underweight, and being a Black or Hispanic person are risk factors for nonlobar intracerebral hemorrhage only. Hence, the term hypertensive intracerebral hemorrhage for nonlobar intracerebral hemorrhage is not appropriate.
Collapse
Affiliation(s)
- Wilmar M T Jolink
- From the Department of Neurology and Neurosurgery (W.M.T.J., G.J.E.R., A.A., C.J.M.K.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht Brain Center, Utrecht University; and Department of Neurology (K.W., F.-E.d.L., C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Kim Wiegertjes
- From the Department of Neurology and Neurosurgery (W.M.T.J., G.J.E.R., A.A., C.J.M.K.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht Brain Center, Utrecht University; and Department of Neurology (K.W., F.-E.d.L., C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gabriël J E Rinkel
- From the Department of Neurology and Neurosurgery (W.M.T.J., G.J.E.R., A.A., C.J.M.K.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht Brain Center, Utrecht University; and Department of Neurology (K.W., F.-E.d.L., C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ale Algra
- From the Department of Neurology and Neurosurgery (W.M.T.J., G.J.E.R., A.A., C.J.M.K.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht Brain Center, Utrecht University; and Department of Neurology (K.W., F.-E.d.L., C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- From the Department of Neurology and Neurosurgery (W.M.T.J., G.J.E.R., A.A., C.J.M.K.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht Brain Center, Utrecht University; and Department of Neurology (K.W., F.-E.d.L., C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Catharina J M Klijn
- From the Department of Neurology and Neurosurgery (W.M.T.J., G.J.E.R., A.A., C.J.M.K.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht Brain Center, Utrecht University; and Department of Neurology (K.W., F.-E.d.L., C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
4
|
Dzietko M, Schulz S, Preuss M, Haertel C, Stein A, Felderhoff-Mueser U, Goepel W. Apolipoprotein E gene polymorphisms and intraventricular haemorrhage in infants born preterm: a large prospective multicentre cohort study. Dev Med Child Neurol 2019; 61:337-342. [PMID: 30084487 DOI: 10.1111/dmcn.13987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
AIM Infants born preterm are at risk of intraventricular haemorrhage (IVH) but individual susceptibility related to genes is not well defined in this vulnerable population. Apolipoprotein genotypes APOE2 and APOE4 increase the hazard of cerebral haemorrhages in adults. We investigated whether APOE is associated with prevalence of IVH and is likely to have a particular genotype. METHOD In this prospective study, 5075 infants born preterm with genotype APOE3 were compared to 965 (APOE2) and 1912 (APOE4) individuals, to analyse the association between APOE genotype and grade III and IV IVH. We used a logistic regression model including gestational age, antenatal steroid treatment, 5-minute Apgar scores less than 3, intubation, pneumothorax, small for gestational age, multiple birth, sex, and maternal descent as independent factors. RESULTS The APOE2 (20.1%) and APOE4 (19.8%) genotypes were significantly more prevalent in infants with IVH than in those with the APOE3 haplotype (17.4%) (APOE2: odds ratio [OR] 1.33, 95% confidence interval [CI] 1.00-1.76; APOE4: OR 1.39, 95% CI 1.12-1.74). Infants with two polymorphisms had the highest risk of IVH (8.7%; OR 1.63, 95% CI 1.09-2.45). INTERPRETATION APOE2 and APOE4 genotypes are relevant risk factors for IVH in infants born preterm. Our findings improve our understanding of the genetic contributions to IVH.
Collapse
Affiliation(s)
- Mark Dzietko
- Department of Pediatrics I, University Duisburg-Essen, Essen, Germany
| | - Soeren Schulz
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Michael Preuss
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | | | - Anja Stein
- Department of Pediatrics I, University Duisburg-Essen, Essen, Germany
| | | | - Wolfgang Goepel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| |
Collapse
|
5
|
Marini S, Devan WJ, Radmanesh F, Miyares L, Poterba T, Hansen BM, Norrving B, Jimenez-Conde J, Giralt-Steinhauer E, Elosua R, Cuadrado-Godia E, Soriano C, Roquer J, Kourkoulis CE, Ayres AM, Schwab K, Tirschwell DL, Selim M, Brown DL, Silliman SL, Worrall BB, Meschia JF, Kidwell CS, Montaner J, Fernandez-Cadenas I, Delgado P, Greenberg SM, Lindgren A, Matouk C, Sheth KN, Woo D, Anderson CD, Rosand J, Falcone GJ. 17p12 Influences Hematoma Volume and Outcome in Spontaneous Intracerebral Hemorrhage. Stroke 2018; 49:1618-1625. [PMID: 29915124 PMCID: PMC6085089 DOI: 10.1161/strokeaha.117.020091] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/13/2018] [Accepted: 05/15/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE Hematoma volume is an important determinant of clinical outcome in spontaneous intracerebral hemorrhage (ICH). We performed a genome-wide association study (GWAS) of hematoma volume with the aim of identifying novel biological pathways involved in the pathophysiology of primary brain injury in ICH. METHODS We conducted a 2-stage (discovery and replication) case-only genome-wide association study in patients with ICH of European ancestry. We utilized the admission head computed tomography to calculate hematoma volume via semiautomated computer-assisted technique. After quality control and imputation, 7 million genetic variants were available for association testing with ICH volume, which was performed separately in lobar and nonlobar ICH cases using linear regression. Signals with P<5×10-8 were pursued in replication and tested for association with admission Glasgow coma scale and 3-month post-ICH dichotomized (0-2 versus 3-6) modified Rankin Scale using ordinal and logistic regression, respectively. RESULTS The discovery phase included 394 ICH cases (228 lobar and 166 nonlobar) and identified 2 susceptibility loci: a genomic region on 22q13 encompassing PARVB (top single-nucleotide polymorphism rs9614326: β, 1.84; SE, 0.32; P=4.4×10-8) for lobar ICH volume and an intergenic region overlying numerous copy number variants on 17p12 (top single-nucleotide polymorphism rs11655160: β, 0.95; SE, 0.17; P=4.3×10-8) for nonlobar ICH volume. The replication included 240 ICH cases (71 lobar and 169 nonlobar) and corroborated the association for 17p12 (P=0.04; meta-analysis P=2.5×10-9; heterogeneity, P=0.16) but not for 22q13 (P=0.49). In multivariable analysis, rs11655160 was also associated with lower admission Glasgow coma scale (odds ratio, 0.17; P=0.004) and increased risk of poor 3-month modified Rankin Scale (odds ratio, 1.94; P=0.045). CONCLUSIONS We identified 17p12 as a novel susceptibility risk locus for hematoma volume, clinical severity, and functional outcome in nonlobar ICH. Replication in other ethnicities and follow-up translational studies are needed to elucidate the mechanism mediating the observed association.
Collapse
Affiliation(s)
- Sandro Marini
- From the Center for Genomic Medicine (S.M., W.J.D., F.R., C.E.K., C.D.A., J.R.)
| | - William J Devan
- From the Center for Genomic Medicine (S.M., W.J.D., F.R., C.E.K., C.D.A., J.R.)
| | - Farid Radmanesh
- From the Center for Genomic Medicine (S.M., W.J.D., F.R., C.E.K., C.D.A., J.R.)
| | - Laura Miyares
- Massachusetts General Hospital, Boston; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., C.M., K.N.S., G.J.F.)
| | | | - Björn M Hansen
- Department of Neurology and Rehabilitation, Skåne University Hospital, Lund, Sweden (B.M.H., B.N., A.L.)
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden (B.M.H., B.N., A.L.)
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (B.M.H., B.N., A.L.)
| | - Bo Norrving
- Department of Neurology and Rehabilitation, Skåne University Hospital, Lund, Sweden (B.M.H., B.N., A.L.)
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden (B.M.H., B.N., A.L.)
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (B.M.H., B.N., A.L.)
| | - Jordi Jimenez-Conde
- Department of Neurology, Hospital del Mar Medical Research Institute (IMIM) (J.J.-C., E.G.-S., R.E., E.C.-G., C.S., J.R.)
| | - Eva Giralt-Steinhauer
- Department of Neurology, Hospital del Mar Medical Research Institute (IMIM) (J.J.-C., E.G.-S., R.E., E.C.-G., C.S., J.R.)
| | - Roberto Elosua
- Department of Neurology, Hospital del Mar Medical Research Institute (IMIM) (J.J.-C., E.G.-S., R.E., E.C.-G., C.S., J.R.)
| | - Elisa Cuadrado-Godia
- Department of Neurology, Hospital del Mar Medical Research Institute (IMIM) (J.J.-C., E.G.-S., R.E., E.C.-G., C.S., J.R.)
| | - Carolina Soriano
- Department of Neurology, Hospital del Mar Medical Research Institute (IMIM) (J.J.-C., E.G.-S., R.E., E.C.-G., C.S., J.R.)
| | - Jaume Roquer
- Department of Neurology, Hospital del Mar Medical Research Institute (IMIM) (J.J.-C., E.G.-S., R.E., E.C.-G., C.S., J.R.)
| | | | - Alison M Ayres
- Universitat Autónoma de Barcelona, Spain; Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (A.M.A., K.S., S.M.G.)
| | - Kristin Schwab
- Universitat Autónoma de Barcelona, Spain; Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (A.M.A., K.S., S.M.G.)
| | - David L Tirschwell
- Stroke Center, Harborview Medical Center, University of Washington, Seattle (D.L.T.)
| | - Magdy Selim
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.)
| | - Devin L Brown
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor (D.L.B.)
| | - Scott L Silliman
- Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.)
| | - Bradford B Worrall
- Department of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.)
| | | | - Joan Montaner
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron (J.M., I.F.-C., P.D.)
| | - Israel Fernandez-Cadenas
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron (J.M., I.F.-C., P.D.)
- Stroke Pharmacogenomics and Genetics Sant Pau Institute of Research, Barcelona, Spain (I.F.-C.)
| | - Pilar Delgado
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron (J.M., I.F.-C., P.D.)
| | - Steven M Greenberg
- Universitat Autónoma de Barcelona, Spain; Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (A.M.A., K.S., S.M.G.)
| | - Arne Lindgren
- Department of Neurology and Rehabilitation, Skåne University Hospital, Lund, Sweden (B.M.H., B.N., A.L.)
- Department of Clinical Sciences Lund, Neurology, Lund University, Sweden (B.M.H., B.N., A.L.)
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (B.M.H., B.N., A.L.)
| | - Charles Matouk
- Massachusetts General Hospital, Boston; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., C.M., K.N.S., G.J.F.)
| | - Kevin N Sheth
- Massachusetts General Hospital, Boston; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., C.M., K.N.S., G.J.F.)
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (D.W.)
| | - Christopher D Anderson
- From the Center for Genomic Medicine (S.M., W.J.D., F.R., C.E.K., C.D.A., J.R.)
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston (C.D.A., J.R.)
- Program in Medical and Population Genetics, Broad Institute, Boston (C.D.A., J.R)
| | - Jonathan Rosand
- From the Center for Genomic Medicine (S.M., W.J.D., F.R., C.E.K., C.D.A., J.R.)
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston (C.D.A., J.R.)
- Program in Medical and Population Genetics, Broad Institute, Boston (C.D.A., J.R)
| | - Guido J Falcone
- Massachusetts General Hospital, Boston; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., C.M., K.N.S., G.J.F.)
| |
Collapse
|
6
|
Carpenter AM, Singh IP, Gandhi CD, Prestigiacomo CJ. Genetic risk factors for spontaneous intracerebral haemorrhage. Nat Rev Neurol 2015; 12:40-9. [PMID: 26670299 DOI: 10.1038/nrneurol.2015.226] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intracerebral haemorrhage (ICH) is associated with the greatest morbidity and mortality of all stroke subtypes. Established risk factors for ICH include hypertension, alcohol use, current cigarette smoking, and use of oral anticoagulants and/or antiplatelet agents. Familial aggregation of ICH has been observed, and the heritability of ICH risk has been estimated at 44%. Few genes have been found to be associated with ICH at the population level, and much of the evidence for genetic risk factors for ICH comes from single studies conducted in relatively small and homogenous populations. In this Review, we summarize the current knowledge of genetic variants associated with primary spontaneous ICH. Two variants of the gene encoding apolipoprotein E (APOE) - which also contributes to the pathogenesis of cerebral amyloid angiopathy - are the most likely candidates for variants that increase the risk of ICH. Other promising candidates for risk alleles in ICH include variants of the genes ACE, PMF1/SLC25A44, COL4A2, and MTHFR. Other genetic variants, related to haemostasis, lipid metabolism, inflammation, and the CNS microenvironment, have been linked to ICH in single candidate gene studies. Although evidence for genetic contributions to the risk of ICH exists, we do not yet fully understand how and to what extent this information can be utilized to prevent and treat ICH.
Collapse
Affiliation(s)
- Amanda M Carpenter
- St. George's University, 3500 Sunrise Highway, Great River, NY 11739, USA
| | - Inder P Singh
- Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street Suite 8100, Newark, New Jersey 07103, USA
| | - Chirag D Gandhi
- Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street Suite 8100, Newark, New Jersey 07103, USA
| | - Charles J Prestigiacomo
- Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street Suite 8100, Newark, New Jersey 07103, USA
| |
Collapse
|