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Published on: June 18, 2021
Idiopathic primary intraventricular hemorrhage and cerebral small vessel disease
Alvin S Das1, Robert W Regenhardt1, Elif Gokcal1
1Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Idiopathic primary intraventricular hemorrhage (IP-IVH) may be linked to cerebral small vessel diseases (cSVD). This study found similar rates of cerebral amyloid angiopathy and hypertensive cSVD in IP-IVH patients compared to those with primary intraparenchymal hemorrhage.
Area of Science:
- Neurology
- Neuroradiology
- Vascular Neurology
Background:
- The causes of idiopathic primary intraventricular hemorrhage (IP-IVH) remain largely undefined.
- While trauma and vascular lesions are common causes, a significant portion of IP-IVH cases lack a clear etiology.
Purpose of the Study:
- To investigate the potential association between cerebral small vessel diseases (cSVD) and IP-IVH.
- To test the hypothesis that hypertensive cSVD (HTN-cSVD) and cerebral amyloid angiopathy contribute to IP-IVH.
Main Methods:
- Retrospective review of brain MRI scans from 1276 patients with non-traumatic intracerebral hemorrhage.
- Assessment for HTN-cSVD (defined by deep/mixed ICH or microbleeds) and cerebral amyloid angiopathy (using modified Boston criteria).
- Comparison of cSVD prevalence between IP-IVH patients and primary intraparenchymal hemorrhage (P-IPH) patients.
Main Results:
- Forty-six patients (4%) were identified with IP-IVH, predominantly older individuals with hypertension.
- Cerebral amyloid angiopathy was present in approximately one-third of IP-IVH patients (possible/probable criteria).
- HTN-cSVD was detected in 23% of IP-IVH patients. Prevalence rates for both conditions were similar to P-IPH patients.
Conclusions:
- The findings suggest that both cerebral amyloid angiopathy and HTN-cSVD may be associated with IP-IVH.
- These cSVD subtypes appear to be present in IP-IVH at rates comparable to P-IPH.
- Further research is warranted to elucidate the specific role of cSVD in the pathogenesis of IP-IVH.
Background:
Although primary intraventricular hemorrhage is frequently due to trauma or vascular lesions, the etiology of idiopathic primary intraventricular hemorrhage (IP-IVH) is not defined.
Aims:
Herein, we test the hypothesis that cerebral small vessel diseases (cSVD) including hypertensive cSVD (HTN-cSVD) and cerebral amyloid angiopathy are associated with IP-IVH.
Methods:
Brain magnetic resonance imaging from consecutive patients (January 2011 to September 2019) with non-traumatic intracerebral hemorrhage from a single referral center were reviewed for the presence of HTN-cSVD (defined by strictly deep or mixed-location intracerebral hemorrhage/cerebral microbleeds) and cerebral amyloid angiopathy (applying modified Boston criteria).
Results:
Forty-six (4%) out of 1276 patients were identified as having IP-IVH. Among these, the mean age was 74.4 ± 12.2 years and 18 (39%) were females. Forty (87%) had hypertension, and the mean initial blood pressure was 169.2 ± 40.4/88.8 ± 22.2 mmHg. Of the 35 (76%) patients who received a brain magnetic resonance imaging, two (6%) fulfilled the modified Boston criteria for possible cerebral amyloid angiopathy and 10 (29%) for probable cerebral amyloid angiopathy. Probable cerebral amyloid angiopathy was found at a similar frequency when comparing IP-IVH patients to the remaining patients with primary intraparenchymal hemorrhage (P-IPH) (27%, p = 0.85). Furthermore, imaging evidence for HTN-cSVD was found in 8 (24%) patients with IP-IVH compared to 209 (28%, p = 0.52) patients with P-IPH.
Conclusions:
Among IP-IVH patients, cerebral amyloid angiopathy was found in approximately one-third of patients, whereas HTN-cSVD was detected in 23%-both similar rates to P-IPH patients. Our results suggest that both cSVD subtypes may be associated with IP-IVH.
