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Abstract
Objective: To identify predictors of early lobar intracerebral hemorrhage (ICH) recurrence, defined as a new ICH within 6 months of the index event, in patients with cerebral amyloid angiopathy (CAA).
Methods: Participants were consecutive survivors (age ≥55 years) of spontaneous symptomatic probable or possible CAA-related lobar ICH according to the Boston criteria, drawn from an ongoing single-center cohort study. Neuroimaging markers ascertained in CT or MRI included focal (≤3 sulci) or disseminated (>3 sulci) cortical superficial siderosis (cSS), acute convexity subarachnoid hemorrhage (cSAH), cerebral microbleeds, white matter hyperintensities burden and location, and baseline ICH volume. Participants were followed prospectively for recurrent symptomatic ICH. Cox proportional hazards models were used to identify predictors of early recurrent ICH adjusting for potential confounders.
Results: A total of 292 patients were enrolled. Twenty-one patients (7%) had early recurrent ICH. Of these, 24% had disseminated cSS on MRI and 19% had cSAH on CT scan. In univariable analysis, the presence of disseminated cSS, cSAH, and history of previous ICH were predictors of early recurrent ICH (p < 0.05 for all comparisons). After adjusting for age and history of previous ICH, disseminated cSS on MRI and cSAH on CT were independent predictors of early recurrent ICH (hazard ratio [HR] 3.92, 95% confidence interval [CI] 1.38–11.17, p = 0.011, and HR 3.48, 95% CI 1.13–10.73, p = 0.030, respectively).
Conclusions: Disseminated cSS on MRI and cSAH on CT are independent imaging markers of increased risk for early recurrent ICH. These markers may provide additional insights into the mechanisms of ICH recurrence in patients with CAA.
GLOSSARY
- BP=
- blood pressure;
- CAA=
- cerebral amyloid angiopathy;
- CMB=
- cerebral microbleed;
- cSS=
- cortical superficial siderosis;
- CT-WMH=
- CT-defined white matter hypodensity;
- FLAIR=
- fluid-attenuated inversion recovery;
- HTN=
- hypertension;
- ICH=
- intracerebral hemorrhage;
- IQR=
- interquartile range;
- MGH=
- Massachusetts General Hospital;
- SWI=
- susceptibility-weighted imaging;
- T2*GRE=
- T2*-weighted gradient-recalled echo;
- VIF=
- variance inflation factor
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
Editorial, page 1854
- Received February 11, 2016.
- Accepted in final form June 30, 2016.
- © 2016 American Academy of Neurology
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