Roongpiboonsopit Duangnapa, Charidimou Andreas, William Christopher M, Lauer Arne, Falcone Guido J, Martinez-Ramirez Sergi, Biffi Alessandro, Ayres Alison, Vashkevich Anastasia, Awosika Oluwole O, Rosand Jonathan, Gurol M Edip, Silverman Scott B, Greenberg Steven M, Viswanathan Anand
From The Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center (D.R., A.C., A.L., G.J.F., S.M.-R., A.A., A. Vashkevich, M.E.G., S.B.S., S.M.G., A. Viswanathan), and Division of Behavioral Neurology (A.B.), Department of Neurology, Division of Neuropsychiatry, Department of Psychiatry (A.B.), Neuropathology Service, Department of Pathology (C.M.W.), and The Center for Human Genetic Research (G.J.F., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; and Human Cortical Physiology and Stroke Neurorehabilitation Section (O.O.A.), NINDS/NIH, Bethesda, MD.
Neurology. 2016 Nov 1;87(18):1863-1870. doi: 10.1212/WNL.0000000000003281. Epub 2016 Sep 30.
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).
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.
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).
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.
确定脑淀粉样血管病（CAA）患者早期脑叶脑出血（ICH）复发的预测因素，早期ICH复发定义为在首次事件发生后6个月内出现新的ICH。
参与者为根据波士顿标准确诊为可能或疑似CAA相关脑叶ICH的有症状的连续幸存者（年龄≥55岁），来自一项正在进行的单中心队列研究。在CT或MRI中确定的神经影像学标志物包括局灶性（≤3个脑沟）或弥漫性（>3个脑沟）皮质表面铁沉积（cSS）、急性凸面蛛网膜下腔出血（cSAH）、脑微出血、白质高信号负担及位置，以及基线ICH体积。对参与者进行前瞻性随访，观察复发性有症状ICH的发生情况。采用Cox比例风险模型确定早期复发性ICH的预测因素，并对潜在混杂因素进行校正。
共纳入292例患者。21例（7%）发生早期复发性ICH。其中，24%的患者MRI显示有弥漫性cSS，19%的患者CT扫描显示有cSAH。在单变量分析中，弥漫性cSS、cSAH的存在以及既往ICH病史是早期复发性ICH的预测因素（所有比较p<0.05）。在对年龄和既往ICH病史进行校正后，MRI上的弥漫性cSS和CT上的cSAH是早期复发性ICH的独立预测因素（风险比[HR]分别为3.92，95%置信区间[CI]为1.38 - 11.17，p = 0.011；HR为3.48，95%CI为1.13 - 10.73，p = 0.030）。
MRI上的弥漫性cSS和CT上的cSAH是早期复发性ICH风险增加的独立影像学标志物。这些标志物可能为CAA患者ICH复发的机制提供更多见解。
