Das Alvin S, Abramovitz Fouks Avia, Gökçal Elif, Rotschild Ofer, Pasi Marco, Regenhardt Robert W, Goldstein Joshua N, Viswanathan Anand, Rosand Jonathan, Greenberg Steven M, Gurol M Edip
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Lowry Medical Office Building, Ste 9A-05, Boston, MA, 02215, USA.
J Neurol. 2025 Jan 24;272(2):167. doi: 10.1007/s00415-025-12905-8.
While cerebral amyloid angiopathy is likely responsible for intracerebral hemorrhage (ICH) occurring in superficial (grey matter, vermis) cerebellar locations, it is unclear whether hypertensive arteriopathy (HA), the other major cerebral small vessel disease (cSVD), is associated with cerebellar ICH (cICH) in deep (white matter, deep nuclei, cerebellar peduncle) regions. We tested the hypothesis that HA-associated neuroimaging markers are significantly associated with deep cICH compared to superficial cICH.
Brain MRI scans from consecutive non-traumatic cICH patients admitted to a referral center were analyzed for cSVD markers. Clinical risk factors, left ventricular hypertrophy (LVH, a marker of hypertensive end-organ damage), and neuroimaging markers were compared between patients with deep and superficial cICH in univariate and multivariable models.
Hypertension and LVH were more common among 83 (64%) patients with deep cICH compared to 46 (36%) with superficial cICH. HA-related markers such as peri-basal ganglia white matter hyperintensity pattern, deep lacunes, severe basal ganglia enlarged perivascular spaces, and deep cerebral microbleeds (CMBs) were more common among those with deep vs. superficial cICH. Strictly lobar CMBs were less common among patients with deep cICH, whereas mixed-location CMBs were more common. After multivariable adjustment, LVH (aOR 4.06, 95% CI [1.22-13.50], p = 0.02), deep lacunes (aOR 6.02, 95% CI [1.46-24.89], p = 0.01), and strictly lobar CMBs (aOR 0.09, 95% CI [0.02-0.45], p < 0.01) remained significantly associated with deep cICH.
Because HA-associated markers are significantly associated with deep cICH, it is likely HA is the dominant underlying microangiopathy of this ICH subtype.
虽然脑淀粉样血管病可能是导致浅表（灰质、蚓部）小脑部位发生脑出血（ICH）的原因，但尚不清楚另一种主要的脑小血管疾病——高血压性动脉病（HA）是否与深部（白质、深部核团、小脑脚）区域的小脑ICH（cICH）有关。我们检验了这样一个假设，即与HA相关的神经影像学标志物与深部cICH的相关性显著高于浅表cICH。
对转诊中心收治的连续性非创伤性cICH患者的脑部MRI扫描进行分析，以确定脑小血管病标志物。在单变量和多变量模型中，比较深部和浅表cICH患者的临床危险因素、左心室肥厚（LVH，高血压终末器官损害的标志物）和神经影像学标志物。
83例（64%）深部cICH患者中高血压和LVH比46例（36%）浅表cICH患者更常见。与HA相关的标志物，如基底节周围白质高信号模式、深部腔隙、严重的基底节血管周围间隙增宽和深部脑微出血（CMB）在深部cICH患者中比浅表cICH患者更常见。严格局限于脑叶的CMB在深部cICH患者中较少见，而混合部位的CMB更常见。多变量调整后，LVH（调整后比值比[aOR]4.06，95%置信区间[CI][1.22 - 13.50]，p = 0.02）、深部腔隙（aOR 6.02，95% CI[1.46 - 24.89]，p = 0.01）和严格局限于脑叶的CMB（aOR 0.09，95% CI[0.02 - 0.45]，p < 0.01）仍与深部cICH显著相关。
由于与HA相关的标志物与深部cICH显著相关，HA很可能是这种ICH亚型的主要潜在微血管病。
