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Cheng Y, Valdés Hernández MDC, Xu M, Zhang S, Pan X, An B, Wardlaw JM, Liu M, Wu B. Differential risk factor profile and neuroimaging markers of small vessel disease between lacunar ischemic stroke and deep intracerebral hemorrhage. Ther Adv Neurol Disord 2024; 17:17562864241253901. [PMID: 38799702 PMCID: PMC11119384 DOI: 10.1177/17562864241253901] [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: 01/16/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background Lacunar ischemic stroke (LIS) and deep intracerebral hemorrhage (dICH) are two stroke phenotypes of deep perforator arteriopathy. It is unclear what factors predispose individuals with deep perforator arteriopathy to either ischemic or hemorrhagic events. Objectives We aimed to investigate risk factors and neuroimaging features of small vessel disease (SVD) associated with LIS versus dICH in a cross-sectional study. Methods We included patients with clinically presenting, magnetic resonance imaging-confirmed LIS or dICH from two tertiary hospitals between 2010 and 2021. We recorded vascular risk factors and SVD markers, including lacunes, white matter hyperintensities (WMH), perivascular spaces (PVS), and cerebral microbleeds (CMB). Logistic regression modeling was used to determine the association between vascular risk factors, SVD markers, and stroke phenotype. We further created WMH probability maps to compare WMH distribution between LIS and dICH. Results A total of 834 patients with LIS (mean age 61.7 ± 12.1 years) and 405 with dICH (57.7 ± 13.2 years) were included. Hypertension was equally frequent between LIS and dICH (72.3% versus 74.8%, p = 0.349). Diabetes mellitus, hyperlipidemia, smoking, and prior ischemic stroke were more associated with LIS [odds ratio (OR) (95% confidence interval (CI)), 0.35 (0.25-0.48), 0.32 (0.22-0.44), 0.31 (0.22-0.44), and 0.38 (0.18-0.75)]. Alcohol intake and prior ICH were more associated with dICH [OR (95% CI), 2.34 (1.68-3.28), 2.53 (1.31-4.92)]. Lacunes were more prevalent in LIS [OR (95% CI) 0.23 (0.11-0.43)], while moderate-to-severe basal-ganglia PVS and CMB were more prevalent in dICH [OR (95% CI) 2.63 (1.35-5.27), 4.95 (2.71-9.42)]. WMH burden and spatial distribution did not differ between groups. Conclusion The microangiopathy underlying LIS and dICH reflects distinct risk profiles and SVD features, hence possibly SVD subtype susceptibility. Prospective studies with careful phenotyping and genetics are needed to clarify the mechanisms underlying this difference.
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Affiliation(s)
- Yajun Cheng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Mangmang Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuting Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohua Pan
- Department of Neurology, Baotou Eighth Hospital, Baotou, China
| | - Baoqiang An
- Department of Neurology, Baotou Central Hospital, Baotou, China
- Center of Cerebrovascular Disease, Inner Mongolia AeroSpace Hospital, Hohhot, China
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
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Goeldlin MB, Vynckier J, Mueller M, Drop B, Maamari B, Vonlanthen N, Siepen BM, Hakim A, Kaesmacher J, Jesse CM, Mueller MD, Meinel TR, Beyeler M, Clénin L, Gralla J, Z’Graggen W, Bervini D, Arnold M, Fischer U, Seiffge DJ. Small vessel disease burden and risk of recurrent cerebrovascular events in patients with lacunar stroke and intracerebral haemorrhage attributable to deep perforator arteriolopathy. Eur Stroke J 2023; 8:989-1000. [PMID: 37632398 PMCID: PMC10683739 DOI: 10.1177/23969873231193237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/23/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION Deep perforator arteriolopathy (DPA) causes intracerebral haemorrhage (ICH) and lacunar strokes (LS). We compare patient characteristics, MRI findings and clinical outcomes among patients with deep ICH and LS. PATIENTS AND METHODS We included patients with MRI-confirmed LS or ICH in the basal ganglia, thalamus, internal capsule or brainstem from the Bernese Stroke Registry. We assessed MRI small vessel disease (SVD) markers, SVD burden score, modified Rankin Scale (mRS) and ischaemic stroke or ICH at 3 months. RESULTS We included 716 patients, 117 patients (16.3%) with deep ICH (mean age (SD) 65.1 (±15.2) years, 37.1% female) and 599 patients (83.7%) with LS (mean age (SD) 69.7 (±13.6) years, 39.9% female). Compared to LS, deep ICH was associated with a higher SVD burden score (median (IQR) 2 (1-2) vs 1 (0-2)), aORshift 3.19, 95%CI 2.15-4.75). Deep ICH patients had more often cerebral microbleeds (deep ICH: 71.6% vs LS: 29.2%, p < 0.001, median count (IQR) 4(2-12) vs 2(1-6)) and a higher prevalence of lacunes (deep ICH: 60.5% vs LS: 27.4% p < 0.001). At 3 months, deep ICH was associated with higher mRS (aORshift 2.16, 95%CI 1.21-3.87). Occurrence of ischaemic stroke was numerically but not significantly higher in deep ICH (4.3% vs 2.9%; p = 0.51). One patient (1.1%) with ICH but none with LS suffered ICH recurrence. DISCUSSION/CONCLUSION DPA manifesting as ICH is associated with more severe MRI SVD burden and worse outcome compared to LS. The short-term risks of subsequent ischaemic stroke and recurrent ICH are similar in ICH and LS patients. This implies potential consequences for future secondary prevention strategies.
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Affiliation(s)
- Martina B Goeldlin
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jan Vynckier
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, Onze-Lieve-Vrouwziekenhuis Aalst, Aalst, Belgium
| | - Madlaine Mueller
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Boudewijn Drop
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Basel Maamari
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Noah Vonlanthen
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Bernhard M Siepen
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christopher Marvin Jesse
- Department of Neurosurgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Mandy D Mueller
- Department of Neurosurgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Morin Beyeler
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Leander Clénin
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jan Gralla
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Werner Z’Graggen
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Neurosurgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - David J Seiffge
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
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Sondag L, Wolsink A, Jolink WMT, Voigt S, van Walderveen MAA, Wermer MJH, Klijn CJM, Schreuder FHBM. The association between blood pressure variability and perihematomal edema after spontaneous intracerebral hemorrhage. Front Neurol 2023; 14:1114602. [PMID: 37006500 PMCID: PMC10060834 DOI: 10.3389/fneur.2023.1114602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundPerihematomal edema (PHE) after spontaneous intracerebral hemorrhage (sICH) is associated with clinical deterioration, but the etiology of PHE development is only partly understood.AimsWe aimed to investigate the association between systemic blood pressure (BP) variability (BPV) and formation of PHE.MethodsFrom a multicenter prospective observational study, we selected patients with sICH who underwent 3T brain MRI within 21 days after sICH, and had at least 5 BP measurements available in the first week after sICH. Primary outcome was the association between coefficient of variation (CV) of systolic BP (SBP) and edema extension distance (EED) using multivariable linear regression, adjusting for age, sex, ICH volume and timing of the MRI. In addition, we investigated the associations of mean SBP, mean arterial pressure (MAP), their CVs with EED and absolute and relative PHE volume.ResultsWe included 92 patients (mean age 64 years; 74% men; median ICH volume 16.8 mL (IQR 6.6–36.0), median PHE volume 22.5 mL (IQR 10.2–41.4). Median time between symptom onset and MRI was 6 days (IQR 4–11), median number of BP measurements was 25 (IQR 18–30). Log-transformed CV of SBP was not associated with EED (B = 0.050, 95%-CI −0.186 to 0.286, p = 0.673). Furthermore, we found no association between mean SBP, mean and CV of MAP and EED, nor between mean SBP, mean MAP or their CVs and absolute or relative PHE.DiscussionOur results do not support a contributing role for BPV on PHE, suggesting mechanisms other than hydrostatic pressure such as inflammatory processes, may play a more important role.
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Affiliation(s)
- Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Axel Wolsink
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Catharina J. M. Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Floris H. B. M. Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Floris H. B. M. Schreuder
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Cliteur MP, Sondag L, Wolsink A, Rasing I, Meijer FJA, Jolink WMT, Wermer MJH, Klijn CJM, Schreuder FHBM. Cerebral small vessel disease and perihematomal edema formation in spontaneous intracerebral hemorrhage. Front Neurol 2022; 13:949133. [PMID: 35968312 PMCID: PMC9372363 DOI: 10.3389/fneur.2022.949133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Blood-brain barrier (BBB) dysfunction is implicated in the pathophysiology of cerebral small vessel disease (cSVD)-related intracerebral hemorrhage (ICH). The formation of perihematomal edema (PHE) is presumed to reflect acute BBB permeability following ICH. We aimed to assess the association between cSVD burden and PHE formation in patients with spontaneous ICH. Methods We selected patients with spontaneous ICH who underwent 3T MRI imaging within 21 days after symptom onset from a prospective observational multicenter cohort study. We rated markers of cSVD (white matter hyperintensities, enlarged perivascular spaces, lacunes and cerebral microbleeds) and calculated the composite score as a measure of the total cSVD burden. Perihematomal edema formation was measured using the edema extension distance (EED). We assessed the association between the cSVD burden and the EED using a multivariable linear regression model adjusting for age, (log-transformed) ICH volume, ICH location (lobar vs. non-lobar), and interval between symptom onset and MRI. Results We included 85 patients (mean age 63.5 years, 75.3% male). Median interval between symptom onset and MRI imaging was 6 days (IQR 1–19). Median ICH volume was 17.0 mL (IQR 1.4–88.6), and mean EED was 0.54 cm (SD 0.17). We found no association between the total cSVD burden and EED (B = −0.003, 95% CI −0.003–0.03, p = 0.83), nor for any of the individual radiological cSVD markers. Conclusion We found no association between the cSVD burden and PHE formation. This implies that mechanisms other than BBB dysfunction are involved in the pathophysiology of PHE.
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Affiliation(s)
- Maaike P. Cliteur
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Axel Wolsink
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ingeborg Rasing
- Department of Neurology & Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - F. J. A. Meijer
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Marieke J. H. Wermer
- Department of Neurology & Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - Catharina J. M. Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Floris H. B. M. Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
- *Correspondence: Floris H. B. M. Schreuder
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