Predictors of localization, outcome, and etiology of spontaneous intracerebral hemorrhages: focus on cerebral amyloid angiopathy
Open Access
- 18 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Neural Transmission
- Vol. 127 (6), 963-972
- https://doi.org/10.1007/s00702-020-02174-2
Abstract
Despite its clinical relevance, cerebral amyloid angiopathy (CAA) is underdiagnosed worldwide. This retrospective study aimed to assess the incidence, etiology, predictors, and outcome of intracerebral hemorrhages (ICHs) in this region, with special focus on possible underlying CAA. Database screening of acute cares with intracranial hemorrhage diagnosis within 01/07/2014-01/07/2018 were conducted analyzing medical records and imaging. Spontaneous ICHs were classified as deep (basal ganglionic/thalamic/brainstem) and lobar/cerebellar (i.e., CAA-compatible) ICHs. Probable/definite CAA was established using the modified Boston criteria in a subgroup with 'complete' radiological/neuropathological work-up. The ability of several factors to discriminate between deep and lobar/cerebellar ICHs, between probable/definite CAA and non-probable CAA cases, and to predict 1-month case fatality was assessed. Of the 213 ICHs identified, 121 were in deep and 92 in lobar/cerebellar localization. Sub-analysis of 47 lobar/cerebellar ICHs with 'complete' work-up identified 16 probable/definite CAA patients, yielding an estimated 14.7% prevalence of CAA-related ICHs. Chronic hypertension was the most prevalent risk factor for all types of ICHs (including CAA-related), with hypertensive excess and younger age being independent predictors of deep whereas antiplatelet use of lobar/cerebellar localization. The 1-month case fatality was 33.8%, driven predominantly by age and INR > 1.4. Probable/definite CAA diagnosis was independently predicted by age, prior intracranial hemorrhage, and antiplatelet use. First in this region and among the few in the literature, this study reports a remarkable prevalence of CAA-related ICHs, emphasizing the need for an increased awareness of CAA and its therapeutic implications, especially regarding antiplatelets among the elderly.Keywords
Funding Information
- Magyar Tudományos Akadémia (János Bolyai Research Scholarship, János Bolyai Research Scholarship)
- Emberi Eroforrások Minisztériuma (ÚNKP-18-4, ÚNKP-18-4)
- Nemzeti Fejlesztési Minisztérium (ÚNKP-19-4, ÚNKP-19-4)
- Nemzeti Kutatási Fejlesztési és Innovációs Hivatal (GINOP 2.3.2-15-2016-00048 STAY ALIVE, TUDFO 47138-0/2019-ITM)
- University of Szeged Open Access Fund (4575)
This publication has 40 references indexed in Scilit:
- SMASH-UStroke, 2012
- International Epidemiology of Intracerebral HemorrhageCurrent Atherosclerosis Reports, 2012
- Cerebral Amyloid Angiopathy: A Systematic ReviewJournal of Clinical Neurology, 2011
- Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathyNeurology, 2010
- Prevalence of superficial siderosis in patients with cerebral amyloid angiopathyNeurology, 2010
- Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic reviewThe Lancet Neurology, 2009
- Cerebral microbleeds: a guide to detection and interpretationThe Lancet Neurology, 2009
- Blood Pressure in Relation to the Incidence of Cerebral Infarction and Intracerebral HemorrhageStroke, 2007
- Risk Factors for Intracerebral Hemorrhage in the General PopulationStroke, 2003
- Alzheimer disease and cerebrovascular pathology: an updateJournal of Neural Transmission, 2002