From the Department of Neurology (S.F.-H., L.O., C.K., L.F., M.K., C.E., T.G.), Medical University of Graz, Austria; Stroke Research Centre (S.F.-H., G.B., P.S.N., W.Z., H.O., M.L., Y.D., L.P., R.M., K.T., R.J.S., D.J.W.), Department of Brain Repair & Rehabilitation, UCL Queen Square Institute of Neurology; Department of Statistical Science (G.A.), University College London; MRC Prion Unit at UCL (G.B.), Institute of Prion Diseases, London, United Kingdom; Institute for Medical Informatics, Statistics and Documentation (G.W.), and Division of Neuroradiology, Vascular and Interventional Radiology (M.K.), Department of Radiology, Medical University of Graz, Austria; and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom.
Neurology. 2024 Sep 10;103(5):e209770. doi: 10.1212/WNL.0000000000209770. Epub 2024 Aug 16.
Cerebral amyloid angiopathy (CAA)-associated lobar intracerebral hemorrhage (ICH) has a high risk of recurrence, but the underlying mechanisms remain uncertain. We, therefore, aimed to characterize patterns of recurrent ICH.
We investigated early recurrent ICH (≥1 recurrent ICH event within 90 days of the index event) and ICH clusters (≥2 ICH events within 90 days at any time point) in 2 large cohorts of consecutive patients with first-ever ICH and available MRI.
In 682 included patients (median age 68 years, 40.3% female, median follow-up time 4.1 years), 18 (2.6%) had an early recurrent ICH, which was associated with higher age and CAA. In patients with probable CAA, the risk of early recurrent ICH was increased 5-fold within the first 3 months compared with during months 4-12 (hazard ratio 5.41, 95% CI 2.18-13.4) while no significant difference was observed in patients without CAA. In patients with an ICH cluster, we observed spatial clustering (recurrent ICH within close proximity of index ICH in 63.0%) and a tendency for multiple sequential hemorrhages (≥3 ICH foci within 3 months in 44.4%).
Our data provide evidence of both temporal and spatial clustering of ICH in CAA, suggesting a transient and localized active bleeding-prone process.
脑淀粉样血管病（CAA）相关性脑叶颅内出血（ICH）复发风险较高，但潜在机制尚不清楚。因此，我们旨在描述复发性 ICH 的模式。
我们研究了 2 个连续的首次ICH 患者队列中，有早期复发性 ICH（ICH 指数事件后 90 天内≥1 次 ICH 事件）和 ICH 簇（任何时间点 90 天内≥2 次 ICH 事件）的患者。
在纳入的 682 例患者中（中位年龄 68 岁，40.3%为女性，中位随访时间为 4.1 年），18 例（2.6%）发生了早期复发性 ICH，与年龄较大和 CAA 有关。在可能患有 CAA 的患者中，与第 4-12 个月相比，ICH 指数事件后前 3 个月内早期复发性 ICH 的风险增加了 5 倍（危险比 5.41，95%置信区间 2.18-13.4），而在无 CAA 的患者中未观察到显著差异。在 ICH 簇患者中，我们观察到空间聚类（复发 ICH 与 ICH 指数事件接近）和多发连续出血的趋势（3 个月内≥3 个 ICH 病灶）。
我们的数据提供了 CAA 中 ICH 存在时间和空间聚类的证据，提示存在短暂的、局部的、易出血过程。
