Arndt Philipp, Chahem Christian, Luchtmann Michael, Kuschel Jan-Niklas, Behme Daniel, Pfister Malte, Neumann Jens, Görtler Michael, Dörner Marc, Pawlitzki Marc, Jansen Robin, Meuth Sven G, Vielhaber Stefan, Henneicke Solveig, Schreiber Stefanie
Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.
German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany.
Front Neurol. 2024 Mar 7;15:1322442. doi: 10.3389/fneur.2024.1322442. eCollection 2024.
Sporadic cerebral small-vessel disease (CSVD), i.e., hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA), is the main cause of spontaneous intracerebral hemorrhage (ICH). Nevertheless, a substantial portion of ICH cases arises from non-CSVD etiologies, such as trauma, vascular malformations, and brain tumors. While studies compared HA- and CAA-related ICH, non-CSVD etiologies were excluded from these comparisons and are consequently underexamined with regard to additional factors contributing to increased bleeding risk beyond their main pathology.
As a proof of concept, we conducted a retrospective observational study in 922 patients to compare HA, CAA, and non-CSVD-related ICH with regard to factors that are known to contribute to spontaneous ICH onset. Medical records (available for = 861) were screened for demographics, antithrombotic medication, and vascular risk profile, and CSVD pathology was rated on magnetic resonance imaging (MRI) in a subgroup of 185 patients. The severity of CSVD was assessed with a sum score ranging from 0 to 6, where a score of ≥2 was defined as advanced pathology.
In 922 patients with ICH (median age of 71 years), HA and CAA caused the majority of cases ( = 670, 73%); non-CSVD etiologies made up the remaining quarter ( = 252, 27%). Individuals with HA- and CAA-related ICH exhibited a higher prevalence of predisposing factors than those with non-CSVD etiologies. This includes advanced age (median age: 71 vs. 75 vs. 63 years, < 0.001), antithrombotic medication usage (33 vs. 37 vs. 19%, < 0.001), prevalence of vascular risk factors (70 vs. 67 vs. 50%, < 0.001), and advanced CSVD pathology on MRI (80 vs. 89 vs. 51%, > 0.001). However, in particular, half of non-CSVD ICH patients were either aged over 60 years, presented with vascular risk factors, or had advanced CSVD on MRI.
Risk factors for spontaneous ICH are less common in non-CSVD ICH etiologies than in HA- and CAA-related ICH, but are still frequent. Future studies should incorporate these factors, in addition to the main pathology, to stratify an individual's risk of bleeding.
散发性脑小血管病（CSVD），即高血压性动脉病（HA）和脑淀粉样血管病（CAA），是自发性脑出血（ICH）的主要原因。然而，相当一部分ICH病例源于非CSVD病因，如创伤、血管畸形和脑肿瘤。虽然已有研究比较了与HA和CAA相关的ICH，但这些比较中排除了非CSVD病因，因此，对于除主要病理之外导致出血风险增加的其他因素，这些病因的研究仍不充分。
作为概念验证，我们对922例患者进行了一项回顾性观察研究，以比较HA、CAA和与非CSVD相关的ICH在已知导致自发性ICH发病的因素方面的差异。筛查了病历（n = 861）中的人口统计学信息、抗血栓药物使用情况和血管风险状况，并对185例患者亚组的磁共振成像（MRI）进行CSVD病理评分。采用总分0至6分评估CSVD的严重程度，≥2分定义为晚期病理。
在922例ICH患者（中位年龄71岁）中，HA和CAA导致了大多数病例（n = 670，73%）；非CSVD病因占其余四分之一（n = 252，27%）。与HA和CAA相关的ICH患者比非CSVD病因患者的诱发因素患病率更高。这包括高龄（中位年龄：71岁对75岁对63岁，P < 0.001）、抗血栓药物使用情况（33%对37%对19%，P < 0.001）、血管危险因素患病率（70%对67%对50%，P < 0.001）以及MRI上的晚期CSVD病理（80%对89%对51%，P > 0.001）。然而，特别要指出的是，一半的非CSVD ICH患者年龄超过60岁，存在血管危险因素，或MRI显示有晚期CSVD。
自发性ICH的危险因素在非CSVD ICH病因中比在与HA和CAA相关的ICH中少见，但仍然常见。未来的研究除了主要病理外，还应纳入这些因素，以分层评估个体的出血风险。
