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Distribution of white matter hyperintensity in cerebral hemorrhage and healthy aging
Yi-Cheng Zhu1, Hugues Chabriat, Ophélia Godin
1Department of Neurology, Peking Union Medical College Hospital, Beijing, China.
Abstract:
We compared the severity of white matter T2-hyperintensities (WMH) in the frontal lobe and occipital lobe using a visual MRI score in 102 patients with lobar intracerebral hemorrhage (ICH) diagnosed with possible or probable cerebral amyloid angiopathy (CAA), 99 patients with hypertension-related deep ICH, and 159 normal elderly subjects from a population-based cohort. The frontal-occipital (FO) gradient was used to describe the difference in the severity of WMH between the frontal lobe and occipital lobe. A higher proportion of subjects with obvious occipital dominant WMH (FO gradient ≤-2) was found among patients with lobar ICH than among healthy elderly subjects (FO gradient ≤-2: 13.7 vs. 5.7%, p = 0.03). Subjects with obvious occipital dominant WMH were more likely to have more WMH (p = 0.0006) and a significantly higher prevalence of the apolipoprotein E ε4 allele (45.8% vs. 19.4%, p = 0.04) than those who had obvious frontal dominant WMH. This finding is consistent with the relative predilection of CAA for posterior brain regions, and suggests that white matter lesions may preferentially occur in areas of greatest vascular pathology.
Insights
Cerebral amyloid angiopathy (CAA) is linked to occipital white matter lesions, suggesting vascular pathology drives white matter damage. This study found more occipital-dominant white matter hyperintensities in lobar intracerebral hemorrhage patients compared to controls.
Area of Science:
- Neurology
- Neuroradiology
- Genetics
Background:
- White matter hyperintensities (WMH) are common in aging and cerebrovascular disease.
- Cerebral amyloid angiopathy (CAA) is a leading cause of lobar intracerebral hemorrhage (ICH), particularly in older adults.
- The distribution of WMH may reflect underlying pathologies like CAA.
Purpose of the Study:
- To compare the severity and distribution of white matter T2-hyperintensities (WMH) in the frontal and occipital lobes between patients with lobar ICH (suspected CAA), hypertension-related deep ICH, and healthy controls.
- To investigate the association between WMH distribution, overall WMH burden, and the apolipoprotein E (APOE) ε4 allele.
Main Methods:
- Retrospective analysis of MRI scans from 102 patients with lobar ICH (possible/probable CAA), 99 with deep ICH (hypertension), and 159 healthy elderly controls.
- Visual assessment of WMH severity in frontal and occipital lobes using a standardized MRI score.
- Calculation of the frontal-occipital (FO) gradient to quantify WMH distribution differences.
Main Results:
- Patients with lobar ICH showed a significantly higher proportion of occipital-dominant WMH (FO gradient ≤-2) compared to healthy controls (13.7% vs. 5.7%, p=0.03).
- Occipital-dominant WMH was associated with a greater overall WMH burden (p=0.0006) and a higher prevalence of the APOE ε4 allele (45.8% vs. 19.4%, p=0.04).
- Hypertension-related deep ICH patients were not explicitly compared for FO gradient in this abstract.
Conclusions:
- The findings support the predilection of CAA for posterior brain regions.
- White matter lesions may preferentially develop in areas with significant vascular pathology, particularly in CAA.
- WMH distribution and APOE ε4 status may serve as indicators of underlying cerebrovascular disease mechanisms.
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