Related Experiment Video
Updated: Nov 8, 2025
A Volumetric Method for Quantification of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage
Published on: July 28, 2018
Contribution of Racial and Ethnic Differences in Cerebral Small Vessel Disease Subtype and Burden to Risk of Cerebral
Juan Pablo Castello1, Marco Pasi1, Jessica R Abramson1
1From the Department of Neurology (J.P.C., J.R.A., A.R.-T., S.M., P.K., A.C., C.K., Z.D., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., A.B.), Hemorrhagic Stroke Research Program (J.P.C., J.R.A., A.R.-T., S.M., P.K., A.C., C.K, Z.D., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., A.B.), Henry and Allison McCance Center for Brain Health (J.P.C., J.R.A., P.K., C.K., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.M., P.K., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; University of Lille (M.P.), Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, France; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology and Rehabilitation Medicine (S.D., L.G., M.L.F., D.W.), University of Cincinnati, OH; Department of Biostatistics and Data Sciences (C.D.L.), Wake Forest University, Winston-Salem, NC; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California; and Los Angeles County Department of Health Services (A.T.), CA.
Insights
Black and Hispanic individuals with intracerebral hemorrhage (ICH) face higher risks of bleeding recurrence. Differences in chronic small vessel disease (CSVD) severity and type on MRI scans contribute to these racial disparities in ICH recurrence.
Area of Science:
- Neurology
- Radiology
- Public Health
Background:
- Intracerebral hemorrhage (ICH) survivors from Black and Hispanic backgrounds have a higher risk of recurrent intracranial bleeding.
- Chronic cerebral small vessel disease (CSVD) markers on MRI are linked to recurrent ICH.
Purpose of the Study:
- To investigate if racial/ethnic differences in MRI-defined CSVD subtype and severity contribute to disparities in ICH recurrence risk.
Main Methods:
- Analysis of 922 ICH survivors from the Massachusetts General Hospital ICH study and the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study.
- Classification of ICH cases based on CSVD markers (CAA-related, HTNA-related, mixed etiology) using MRI scans within 90 days of index ICH.
- Quantification of global, CAA-specific, and HTNA-specific CSVD burden and comparison among White, Black, and Hispanic survivors.
Main Results:
- Minority ICH survivors exhibited greater global CSVD and hypertensive arteriopathy (HTNA) burden on MRI.
- Minority survivors with HTNA-related and mixed-etiology ICH showed higher HTNA burden, correlating with increased ICH recurrence risk.
Conclusions:
- Significant racial/ethnic differences in CSVD subtypes and severity exist among primary ICH survivors.
- These differences have implications for understanding disparities in ICH recurrence risk.
- Future research should incorporate detailed MRI assessment of CSVD and social determinants of health to address racial/ethnic disparities in ICH outcomes.
Objective:
Black and Hispanic survivors of intracerebral hemorrhage (ICH) are at higher risk of recurrent intracranial bleeding. MRI-based markers of chronic cerebral small vessel disease (CSVD) are consistently associated with recurrent ICH. We therefore sought to investigate whether racial/ethnic differences in MRI-defined CSVD subtype and severity contribute to disparities in ICH recurrence risk.
Methods:
We analyzed data from the Massachusetts General Hospital ICH study (n = 593) and the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study (n = 329). Using CSVD markers derived from MRIs obtained within 90 days of index ICH, we classified ICH cases as cerebral amyloid angiopathy (CAA)-related, hypertensive arteriopathy (HTNA)-related, and mixed etiology. We quantified CSVD burden using validated global, CAA-specific, and HTNA-specific scores. We compared CSVD subtype and severity among White, Black, and Hispanic ICH survivors and investigated its association with ICH recurrence risk.
Results:
We analyzed data for 922 ICH survivors (655 White, 130 Black, 137 Hispanic). Minority ICH survivors had greater global CSVD (p = 0.011) and HTNA burden (p = 0.021) on MRI. Furthermore, minority survivors of HTNA-related and mixed-etiology ICH demonstrated higher HTNA burden, resulting in increased ICH recurrence risk (all p < 0.05).
Conclusions:
We uncovered significant differences in CSVD subtypes and severity among White and minority survivors of primary ICH, with direct implication for known disparities in ICH recurrence risk. Future studies of racial/ethnic disparities in ICH outcomes will benefit from including detailed MRI-based assessment of CSVD subtypes and severity and investigating social determinants of health.
