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Boe NJ, Hald SM, Kristensen AR, Möller S, Bojsen JA, Elhakim MT, Rodrigues MA, Al-Shahi Salman R, Hallas J, García Rodríguez LA, Selim M, Goldstein LB, Gaist D. Association of Antithrombotic Drug Use With Incident Intracerebral Hemorrhage Location. Neurology 2024; 102:e209442. [PMID: 38771998 PMCID: PMC11226324 DOI: 10.1212/wnl.0000000000209442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/01/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Few population-based studies have assessed associations between the use of antithrombotic (platelet antiaggregant or anticoagulant) drugs and location-specific risks of spontaneous intracerebral hemorrhage (s-ICH). In this study, we estimated associations between antithrombotic drug use and the risk of lobar vs nonlobar incident s-ICH. METHODS Using Danish nationwide registries, we identified cases in the Southern Denmark Region of first-ever s-ICH in patients aged 50 years or older between 2009 and 2018. Each verified case was classified as lobar or nonlobar s-ICH and matched to controls in the general population by age, sex, and calendar year. Prior antithrombotic use was ascertained from a nationwide prescription registry. We calculated odds ratios (aORs) for associations between the use of clopidogrel, aspirin, direct oral anticoagulants (DOACs) or vitamin K antagonists (VKA), and lobar and nonlobar ICH in conditional logistic regression analyses that were adjusted for potential confounders. RESULTS A total of 1,040 cases of lobar (47.9% men, mean age [SD] 75.2 [10.7] years) and 1,263 cases of nonlobar s-ICH (54.2% men, mean age 73.6 [11.4] years) were matched to 41,651 and 50,574 controls, respectively. A stronger association with lobar s-ICH was found for clopidogrel (cases: 7.6%, controls: 3.5%; aOR 3.46 [95% CI 2.45-4.89]) vs aspirin (cases: 22.9%, controls: 20.4%; aOR 2.14 [1.74-2.63; p = 0.019). Corresponding estimates for nonlobar s-ICH were not different between clopidogrel (cases: 5.4%, controls: 3.4%; aOR 2.44 [1.71-3.49]) and aspirin (cases: 20.7%, controls: 19.2%; aOR 1.77 [1.47-2.15]; p = 0.12). VKA use was associated with higher odds of both lobar (cases: 14.3%, controls: 6.1%; aOR 3.66 [2.78-4.80]) and nonlobar (cases: 15.4%, controls: 5.5%; aOR 4.62 [3.67-5.82]) s-ICH. The association of DOAC use with lobar s-ICH (cases: 3.5%, controls: 2.7%; aOR 1.66 [1.02-2.70]) was weaker than that of VKA use (p = 0.006). Corresponding estimates for nonlobar s-ICH were not different between DOACs (cases: 5.1%, controls: 2.4%; aOR 3.44 [2.33-5.08]) and VKAs (p = 0.20). DISCUSSION Antithrombotics were associated with higher risks of s-ICH, but the strength of the associations varied by s-ICH location and drug, which may reflect differences in the cerebral microangiopathies associated with lobar vs nonlobar hemorrhages and the mechanisms of drug action.
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Affiliation(s)
- Nils Jensen Boe
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Stine Munk Hald
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Alexandra Redzkina Kristensen
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Sören Möller
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Jonas A Bojsen
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Mohammad Talal Elhakim
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Mark A Rodrigues
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Rustam Al-Shahi Salman
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Jesper Hallas
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Luis A García Rodríguez
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Magdy Selim
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Larry B Goldstein
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - David Gaist
- From the Neurology Research Unit (N.J.B., S.M.H., A.R.K., D.G.), Odense University Hospital; University of Southern Denmark; Open Patient Data Explorative Network (S.M.), Odense University Hospital; Department Clinical Research (S.M.), University of Southern Denmark; Department of Radiology (J.A.B., M.T.E.), Odense University Hospital, Denmark; Centre for Clinical Brain Sciences (M.A.R., R.A.-S.S.), University of Edinburgh, United Kingdom; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine (J.H.), University of Southern Denmark, Odense; Centro Español Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Beth Israel Deaconess Medical Center (M.S.), Harvard Medical School, Boston, MA; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
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Das AS, Mallick A, Mora SA, Keins S, Abramson JR, Castello JP, Pasi M, Kourkoulis CE, Rodriguez-Torres A, Warren AD, Gökçal E, Viswanathan A, Greenberg SM, Anderson CD, Rosand J, Biffi A, Gurol ME. Hypertension control after intracerebral hemorrhage among varying small vessel disease etiologies. Neurol Sci 2024:10.1007/s10072-024-07560-2. [PMID: 38772978 DOI: 10.1007/s10072-024-07560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/25/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Intracerebral hemorrhage (ICH) is attributable to cerebral small vessel disease (cSVD), which includes cerebral amyloid angiopathy (CAA) and hypertensive-cSVD (HTN-cSVD). HTN-cSVD includes patients with strictly deep ICH/microbleeds and mixed location ICH/microbleeds, the latter representing a more severe form of HTN-cSVD. We test the hypothesis that more severe forms of HTN-cSVD are related to worse hypertension control in long-term follow-up after ICH. METHODS From consecutive non-traumatic ICH patients admitted to a tertiary care center, we classified the ICH as CAA, strictly deep ICH/microbleeds, and mixed-location ICH/microbleeds. CSVD burden was quantified using a validated MRI-based score (range: 0-6 points). We created a multivariable (linear mixed effects) model adjusting for age, sex, race, year of inclusion, hypertension, and antihypertensive medication usage to investigate the association of average systolic blood pressure (SBP) during follow-up with cSVD etiology/severity. RESULTS 796 ICH survivors were followed for a median of 48.8 months (IQR 41.5-60.4). CAA-related ICH survivors (n = 373) displayed a lower median SBP (138 mmHg, IQR 133-142 mmHg) compared to those of strictly deep ICH (n = 222, 141 mmHg, IQR 136-143 mmHg, p = 0.04), and mixed location ICH/microbleeds (n = 201, 142 mmHg, IQR 135-144 mmHg, p = 0.02). In the multivariable analysis, mixed location ICH/microbleeds (effect: + 3.8 mmHg, SE: 1.3 mmHg, p = 0.01) and increasing cSVD severity (+ 1.8 mmHg per score point, SE: 0.8 mmHg, p = 0.03) were associated with higher SBP in follow-up. CONCLUSION CSVD severity and subtype predicts long-term hypertension control in ICH patients.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Lowry Medical Office Building, Ste 9A-05, Boston, MA, 02215, USA.
| | - Akashleena Mallick
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samantha A Mora
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sophia Keins
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Jessica R Abramson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Juan Pablo Castello
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Marco Pasi
- Université de Tours, CHU Tours, Tours, France
| | - Christina E Kourkoulis
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Axana Rodriguez-Torres
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrew D Warren
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Elif Gökçal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Christopher D Anderson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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Zhang Y, Hamidi RE, Hadi M. Cerebral Small Vessel Ischemic Disease: A Source of Patient Panic or a Case of Pragmatic Reporting? Semin Roentgenol 2024; 59:157-164. [PMID: 38880514 DOI: 10.1053/j.ro.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Yi Zhang
- Department of Radiology, University of Louisville, 530 South Jackson Street, CCB-C07, Louisville, KY
| | - Ramin E Hamidi
- Department of Radiology, University of Louisville, 530 South Jackson Street, CCB-C07, Louisville, KY.
| | - Mohiuddin Hadi
- Department of Radiology, University of Louisville, 530 South Jackson Street, CCB-C07, Louisville, KY
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Das A, Bhadran B, Sanker V, Suresh V, Agarwal P, Dave T. Pediatric primary intraventricular hemorrhage: A case report of isolated fourth ventricle hemorrhage in a 10-year-old boy. Clin Case Rep 2023; 11:e7952. [PMID: 37767151 PMCID: PMC10520413 DOI: 10.1002/ccr3.7952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Key Clinical Message Primary intraventricular hemorrhage (PIVH) is a rare condition in pediatric patients, presenting with headache, vomiting, and altered mental status. Surgical interventions, such as external ventricular drain placement, followed by ventriculoperitoneal shunting, show promising outcomes. Further research is needed to enhance understanding and optimize management strategies for pediatric PIVH. Abstract This case report describes a 10-year-old boy with isolated primary intraventricular hemorrhage (PIVH) in the fourth ventricle, shedding light on its clinical presentation and management challenges. The patient presented with headache, vomiting, and altered sensorium, and was subsequently diagnosed with obstructive hydrocephalus due to intraventricular bleeding. Emergency external ventricular drain (EVD) insertion was performed, followed by ventriculoperitoneal shunt placement, resulting in a favorable outcome. The etiology of PIVH in children differs from that in adults, with arteriovenous malformations, Moyamoya disease, and aneurysms being commonly implicated causes. Management strategies for pediatric PIVH are challenging due to limited research, but EVD placement and surgical interventions have shown promise.
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Affiliation(s)
- Aswith Das
- MCh NeurosurgeryGovernment TD Medical College HospitalAlappuzhaIndia
- Team ErevnitesTrivandrumIndia
| | - Biju Bhadran
- Team ErevnitesTrivandrumIndia
- Department of NeurosurgeryGovernment Medical CollegeTrivandrumIndia
| | - Vivek Sanker
- Team ErevnitesTrivandrumIndia
- Noorul Islam Institute of Medical SciencesTrivandrumIndia
| | - Vinay Suresh
- Team ErevnitesTrivandrumIndia
- King George's Medical UniversityLucknowIndia
| | - Pratik Agarwal
- Team ErevnitesTrivandrumIndia
- Lokmanya Tilak Municipal Medical College and General HospitalMumbaiIndia
| | - Tirth Dave
- Team ErevnitesTrivandrumIndia
- Bukovinian State Medical UniversityChernivtsiUkraine
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Das AS, Gokcal E, Biffi A, Regenhardt RW, Pasi M, Abramovitz Fouks A, Viswanathan A, Goldstein J, Schwamm LH, Rosand J, Greenberg SM, Gurol ME. Mechanistic Implications of Cortical Superficial Siderosis in Patients With Mixed Location Intracerebral Hemorrhage and Cerebral Microbleeds. Neurology 2023; 101:e636-e644. [PMID: 37290968 PMCID: PMC10424843 DOI: 10.1212/wnl.0000000000207476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertensive cerebral small vessel disease (HTN-cSVD) is the predominant microangiopathy in patients with a combination of lobar and deep cerebral microbleeds (CMBs) and intracerebral hemorrhage (mixed ICH). We tested the hypothesis that cerebral amyloid angiopathy (CAA) is also a contributing microangiopathy in patients with mixed ICH with cortical superficial siderosis (cSS), a marker strongly associated with CAA. METHODS Brain MRIs from a prospective database of consecutive patients with nontraumatic ICH admitted to a referral center were reviewed for the presence of CMBs, cSS, and nonhemorrhagic CAA markers (lobar lacunes, centrum semiovale enlarged perivascular spaces [CSO-EPVS], and multispot white matter hyperintensity [WMH] pattern). The frequencies of CAA markers and left ventricular hypertrophy (LVH), a marker for hypertensive end-organ damage, were compared between patients with mixed ICH with cSS (mixed ICH/cSS[+]) and without cSS (mixed ICH/cSS[-]) in univariate and multivariable models. RESULTS Of 1,791 patients with ICH, 40 had mixed ICH/cSS(+) and 256 had mixed ICH/cSS(-). LVH was less common in patients with mixed ICH/cSS(+) compared with those with mixed ICH/cSS(-) (34% vs 59%, p = 0.01). The frequencies of CAA imaging markers, namely multispot pattern (18% vs 4%, p < 0.01) and severe CSO-EPVS (33% vs 11%, p < 0.01), were higher in patients with mixed ICH/cSS(+) compared with those with mixed ICH/cSS(-). In a logistic regression model, older age (adjusted odds ratio [aOR] 1.04 per year, 95% CI 1.00-1.07, p = 0.04), lack of LVH (aOR 0.41, 95% CI 0.19-0.89, p = 0.02), multispot WMH pattern (aOR 5.25, 95% CI 1.63-16.94, p = 0.01), and severe CSO-EPVS (aOR 4.24, 95% CI 1.78-10.13, p < 0.01) were independently associated with mixed ICH/cSS(+) after further adjustment for hypertension and coronary artery disease. Among ICH survivors, the adjusted hazard ratio of ICH recurrence in patients with mixed ICH/cSS(+) was 4.65 (95% CI 1.38-11.38, p < 0.01) compared with that in patients with mixed ICH/cSS(-). DISCUSSION The underlying microangiopathy of mixed ICH/cSS(+) likely includes both HTN-cSVD and CAA, whereas mixed ICH/cSS(-) is likely driven by HTN-cSVD. These imaging-based classifications can be important to stratify ICH risk but warrant confirmation in studies incorporating advanced imaging/pathology.
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Affiliation(s)
- Alvin S Das
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Elif Gokcal
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alessandro Biffi
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Robert W Regenhardt
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marco Pasi
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Avia Abramovitz Fouks
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joshua Goldstein
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lee H Schwamm
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - M Edip Gurol
- From the Department of Neurology (A.S.D., E.G., A.B., R.W.R., A.A.F., A.V., L.H.S., J.R., S.M.G., M.E.G.), Massachusetts General Hospital, Department of Neurology (A.S.D.), Beth Israel Deaconess Medical Center, and Henry and Allison McCance Center for Brain Health (A.B., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Centre Hospitalier (M.P.), Université de Tours, France; and Department of Emergency Medicine (J.G.), Massachusetts General Hospital, Harvard Medical School, Boston
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6
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Boe NJ, Hald SM, Jensen MM, Bojsen JA, Elhakim MT, Florisson S, Saleh A, Clausen A, Möller S, Harbo FSG, Graumann O, Hallas J, García Rodríguez LA, Al-Shahi Salman R, Goldstein LB, Gaist D. Association Between Statin Use and Intracerebral Hemorrhage Location: A Nested Case-Control Registry Study. Neurology 2023; 100:e1048-e1061. [PMID: 36878720 PMCID: PMC9990851 DOI: 10.1212/wnl.0000000000201664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A causal relationship between statin use and intracerebral hemorrhage (ICH) is uncertain. We hypothesized that an association between long-term statin exposure and ICH risk might vary for different ICH locations. METHODS We conducted this analysis using linked Danish nationwide registries. Within the Southern Denmark Region (population 1.2 million), we identified all first-ever cases of ICH between 2009 and 2018 in persons aged ≥55 years. Patients with medical record-verified diagnoses were classified as having a lobar or nonlobar ICH and matched for age, sex, and calendar year to general population controls. We used a nationwide prescription registry to ascertain prior statin and other medication use that we classified for recency, duration, and intensity. Using conditional logistic regression adjusted for potential confounders, we calculated adjusted ORs (aORs) and corresponding 95% CIs for the risk of lobar and nonlobar ICH. RESULTS We identified 989 patients with lobar ICH (52.2% women, mean age 76.3 years) who we matched to 39,500 controls and 1,175 patients with nonlobar ICH (46.5% women, mean age 75.1 years) who we matched to 46,755 controls. Current statin use was associated with a lower risk of lobar (aOR 0.83; 95% CI, 0.70-0.98) and nonlobar ICH (aOR 0.84; 95% CI, 0.72-0.98). Longer duration of statin use was also associated with a lower risk of lobar (<1 year: aOR 0.89; 95% CI, 0.69-1.14; ≥1 year to <5 years aOR 0.89; 95% CI 0.73-1.09; ≥5 years aOR 0.67; 95% CI, 0.51-0.87; p for trend 0.040) and nonlobar ICH (<1 year: aOR 1.00; 95% CI, 0.80-1.25; ≥1 year to <5 years aOR 0.88; 95% CI 0.73-1.06; ≥5 years aOR 0.62; 95% CI, 0.48-0.80; p for trend <0.001). Estimates stratified by statin intensity were similar to the main estimates for low-medium intensity therapy (lobar aOR 0.82; nonlobar aOR 0.84); the association with high-intensity therapy was neutral. DISCUSSION We found that statin use was associated with a lower risk of ICH, particularly with longer treatment duration. This association did not vary by hematoma location.
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Affiliation(s)
- Nils Jensen Boe
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Stine Munk Hald
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Mie Micheelsen Jensen
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Jonas Asgaard Bojsen
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Mohammad Talal Elhakim
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Sandra Florisson
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Alisa Saleh
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Anne Clausen
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Sören Möller
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Frederik Severin Gråe Harbo
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Ole Graumann
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Jesper Hallas
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Luis Alberto García Rodríguez
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Rustam Al-Shahi Salman
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - Larry B Goldstein
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington
| | - David Gaist
- From the Research Unit for Neurology (N.J.B., S.M.H., M.M.J., S.F., A.S., D.G.), Departments of Radiology (J.A.B., M.T.E., F.S.G.H., O.G.) and Clinical Research (S.M.), and the Open Patient Data Explorative Network (OPEN) (A.C., S.M.), Odense University Hospital, University of Southern Denmark; Department of Clinical Pharmacology (D.M.), Pharmacy and Environmental Medicine, University of Southern Denmark; Centro Espanõl Investigación Farmacoepidemiológica (L.A.G.R.), Madrid, Spain; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, United Kingdom; and Department of Neurology and Kentucky Neuroscience Institute (L.B.G.), University of Kentucky, Lexington.
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Das AS, Gokcal E, Regenhardt RW, Horn MJ, Schwab K, Daoud N, Viswanathan A, Kimberly WT, Goldstein JN, Biffi A, Rost N, Rosand J, Schwamm LH, Greenberg SM, Gurol ME. Improving detection of cerebral small vessel disease aetiology in patients with isolated lobar intracerebral haemorrhage. Stroke Vasc Neurol 2023; 8:26-33. [PMID: 35981809 PMCID: PMC9985798 DOI: 10.1136/svn-2022-001653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE We evaluate whether non-haemorrhagic imaging markers (NHIM) (white matter hyperintensity patterns, lacunes and enlarged perivascular spaces (EPVS)) can discriminate cerebral amyloid angiopathy (CAA) from hypertensive cerebral small vessel disease (HTN-cSVD) among patients with isolated lobar intracerebral haemorrhage (isolated-LICH). METHODS In patients with isolated-LICH, four cSVD aetiologic groups were created by incorporating the presence/distribution of NHIM: HTN-cSVD pattern, CAA pattern, mixed NHIM and no NHIM. CAA pattern consisted of patients with any combination of severe centrum semiovale EPVS, lobar lacunes or multiple subcortical spots pattern. HTN-cSVD pattern consisted of any HTN-cSVD markers: severe basal ganglia PVS, deep lacunes or peribasal ganglia white matter hyperintensity pattern. Mixed NHIM consisted of at least one imaging marker from either pattern. Our hypothesis was that patients with HTN-cSVD pattern/mixed NHIM would have a higher frequency of left ventricular hypertrophy (LVH), which is associated with HTN-cSVD. RESULTS In 261 patients with isolated-LICH, CAA pattern was diagnosed in 93 patients, HTN-cSVD pattern in 53 patients, mixed NHIM in 19 patients and no NHIM in 96 patients. The frequency of LVH was similar among those with HTN-cSVD pattern and mixed NHIM (50% vs 39%, p=0.418) but was more frequent in HTN-cSVD pattern compared with CAA pattern (50% vs 20%, p<0.001). In a regression model, HTN-cSVD pattern (OR: 7.38; 95% CI 2.84 to 19.20) and mixed NHIM (OR: 4.45; 95% CI 1.25 to 15.90) were found to be independently associated with LVH. CONCLUSION Among patients with isolated-LICH, NHIM may help differentiate HTN-cSVD from CAA, using LVH as a marker for HTN-cSVD.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nader Daoud
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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8
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Three major global stroke challenges: Intracranial stenosis, atrial fibrillation, and cerebral small vessel disease. Int J Stroke 2022; 17:596-598. [PMID: 35787072 DOI: 10.1177/17474930221107520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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