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Pathogenetical subtypes of recurrent intracerebral hemorrhage: designations by SMASH-U classification system

Shin-Joe Yeh1, Sung-Chun Tang1, Li-Kai Tsai1

  • 1From the Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.

Stroke
|July 24, 2014
PubMed

Insights

Pathogenetic classification of intracerebral hemorrhage (ICH) subtypes can differ between initial and recurrent events, especially in cases involving cerebral amyloid angiopathy (CAA). Recurrence rates are highest for systemic disease and CAA-related ICH.

Area of Science:

  • Neurology
  • Stroke Research
  • Vascular Medicine

Background:

  • Pathogenetic classification of intracerebral hemorrhage (ICH) is crucial for predicting patient outcomes.
  • The SMASH-U system categorizes ICH into subtypes: structural vascular lesions, medication, cerebral amyloid angiopathy (CAA), systemic disease, hypertension, or undetermined.
  • Understanding pathogenetic differences between first and recurrent ICH is vital for clinical management.

Purpose of the Study:

  • To compare the pathogenetic subtypes of first-ever intracerebral hemorrhage (ICH) with those of recurrent ICH.
  • To analyze the differences in pathogenetic classifications between initial and subsequent ICH events.

Main Methods:

  • Utilized data from 4578 consecutive acute ICH patients from the National Taiwan University Hospital Stroke Registry (1995-2013).
  • Classified patients into six SMASH-U subtypes.
  • Analyzed pathogenetic classifications for first-ever ICH and compared them with recurrent ICH cases.

Main Results:

  • Among 3785 first-ever ICH cases, hypertensive angiopathy (54.9%) was most common, followed by CAA (12.2%).
  • Pathogenetic differences were observed in 18.4% of 185 recurrent ICH cases, notably between CAA and hypertensive angiopathy.
  • ICH recurrence rates were highest for systemic disease- and CAA-related ICH.

Conclusions:

  • Pathogenetic differences between initial and recurrent ICH events occur in nearly one-fifth of patients, particularly those with CAA.
  • The SMASH-U classification may miscategorize patients with concomitant hypertensive angiopathy and CAA.
  • Further investigation into mixed pathogenetic subtypes of ICH is warranted.
Abstract

Keywords:
amyloid angiopathyerebral hemorrhageetiologyhypertensionsurvival

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