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MRI phenotyping of underlying cerebral small vessel disease in mixed hemorrhage patients

Vincent Scheumann1, Frank Schreiber2, Valentina Perosa3

  • 1Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany.

Journal of the Neurological Sciences
|October 17, 2020
PubMed

Insights

Researchers can now better classify patients with mixed cerebral hemorrhages by identifying underlying cerebral small vessel disease (CSVD). Specific MRI markers like cortical superficial siderosis and centrum-semiovale perivascular spaces suggest cerebral amyloid angiopathy contribution.

Area of Science:

  • Neurology
  • Radiology
  • Pathology

Background:

  • Cerebral small vessel disease (CSVD) is a common cause of stroke.
  • Mixed cerebral hemorrhages present a diagnostic challenge.
  • Differentiating between cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy (HA) is crucial for patient management.

Purpose of the Study:

  • To investigate underlying CSVD in patients with mixed cerebral hemorrhages.
  • To phenotype mixed cerebral hemorrhages based on the contribution of CAA vs. HA.
  • To identify specific markers for differentiating CAA and HA in mixed cases.

Main Methods:

  • Brain MRIs of patients with intracerebral hemorrhages (ICHs) and/or cerebral microbleeds (CMBs) were analyzed for CSVD markers.
  • Validated scales were used to assess ICHs, CMBs, cortical superficial siderosis (cSS), white matter hyperintensities, and MRI-visible perivascular spaces (PVS).
  • Patients with mixed hemorrhages were classified into mixed CAA-pattern or mixed HA-pattern based on cSS and/or centrum-semiovale (CSO)-PVS predominance.

Main Results:

  • 97 patients had mixed lobar/deep ICHs/CMBs, showing more similarities to HA in MRI-CSVD markers, vascular risk, and CSF measures.
  • 33 (34%) of mixed patients exhibited cSS, a CSO-PVS predominance pattern, or both, defining them as mixed CAA-pattern cases.
  • Mixed CAA-pattern patients shared more MRI-CSVD, CSF, and genetic similarities with pure CAA patients.

Conclusions:

  • The heterogeneous group of mixed cerebral hemorrhages can be phenotyped by the predominant underlying CSVD.
  • Cortical superficial siderosis (cSS) and CSO-PVS predominance are suggestive markers for CAA contribution in mixed hemorrhages.
  • This phenotyping aids in understanding the etiology and guiding treatment for patients with mixed cerebral hemorrhages.
Abstract

Keywords:
Cerebral amyloid angiopathyCerebral small vessel diseasesCerebrospinal fluidIntracerebral hemorrhageMRIVascular dementia

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