Cerebral small vessel disease burden and functional and radiographic outcomes in intracerebral hemorrhage
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Published on: September 22, 2012
Vasileios-Arsenios Lioutas1, Bo Wu2, Casey Norton3
1Division of Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA. vlioutas@bidmc.harvard.edu.
Insights
Higher cerebral small vessel disease burden and cerebral microbleeds in patients with spontaneous intracerebral hemorrhage are linked to poorer functional recovery. These findings highlight the impact of CSVD on outcomes after ICH.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Cerebral small vessel disease (CSVD) is a common finding in patients with spontaneous intracerebral hemorrhage (ICH).
- The impact of individual CSVD markers and cumulative burden on functional outcomes after ICH is not fully understood.
Purpose of the Study:
- To investigate the association between CSVD markers and burden with functional independence, ambulation, and hematoma expansion in patients with spontaneous ICH.
- To determine if specific CSVD markers or overall CSVD burden predict poor functional recovery.
Main Methods:
- Retrospective analysis of prospectively collected data from 111 spontaneous ICH patients.
- Brain MRI was performed within one month of ictus.
- CSVD markers (cerebral microbleeds, enlarged perivascular spaces, lacunes, white matter hyperintensities) and composite CSVD burden were assessed.
- Functional independence (mRS ≤ 2) and independent ambulation at 90 days were evaluated.
- Hematoma expansion was assessed radiographically.
Main Results:
- Higher total CSVD burden and the presence of cerebral microbleeds (CMBs) were independently associated with lower odds of functional independence at 90 days.
- No significant association was found between CSVD markers or total burden and ambulation or hematoma expansion.
- ICH volume and deep ICH location were key determinants of poor ambulation.
Conclusions:
- In patients with ICH and no prior functional dependence, increased CSVD burden, particularly the presence of CMBs, significantly impairs functional recovery.
- The association between CMBs and reduced functional independence after ICH is a novel finding requiring further investigation.
Objective:
To examine the effect of individual cerebral small vessel disease (CSVD) markers and cumulative CSVD burden on functional independence, ambulation and hematoma expansion in spontaneous intracerebral hemorrhage (ICH).
Methods:
Retrospective analysis of prospectively collected data from an observational study of consecutive patients with spontaneous ICH, brain MRI within 1 month from ictus, premorbid modified Rankin Scale (mRS) score ≤ 2, available imaging data and 90-day functional status in a tertiary academic center. Functional outcomes included 90-day functional independence (mRS ≤ 2) and independent ambulation; radiographic outcome was hematoma expansion (> 12.5 ml absolute or > 33% relative increase in ICH volume). We identified the presence and burden of individual CSVD markers (cerebral microbleeds (CMBs), enlarged perivascular spaces, lacunes, white matter hyperintensities) and composite CSVD burden score and explored their association with outcomes of interest in multivariable models adjusting for well-established confounders.
Results:
111 patients were included, 65% lobar ICH, with a median volume 20.8 ml. 43 (38.7%) achieved functional independence and 71 (64%) independent ambulation. In multivariable adjusted models, there was higher total CSVD burden (OR 0.61, 95% CI 0.37-0.96, p = 0.03) and CMBs presence (OR 0.32, 95% CI 0.1-0.88, p = 0.04) remained independently inversely associated with functional independence. Individual CSVD markers or total CSVD score had no significant relation with ambulation and ICH expansion. Larger ICH volume and deep ICH location were the major determinants of lack of independent ambulation.
Conclusions:
Our findings suggest that in ICH patients without previous functional dependence, total CSVD burden and particularly presence of CMBs significantly affect functional recovery. The latter is a novel finding and merits further exploration.
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