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Risk factors for intracerebral hemorrhage in small-vessel disease and non-small-vessel disease etiologies-an

Philipp Arndt1,2, Christian Chahem1, Michael Luchtmann3,4

  • 1Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.

Frontiers in Neurology
|March 22, 2024
PubMed

Insights

Non-cerebral small-vessel disease (CSVD) causes of intracerebral hemorrhage (ICH) have fewer risk factors than hypertensive arteriopathy (HA) or cerebral amyloid angiopathy (CAA) related ICH, but still occur frequently. Further research should include these factors for better bleeding risk stratification.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Radiology

Background:

  • Cerebral small-vessel disease (CSVD), encompassing hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA), is a primary cause of spontaneous intracerebral hemorrhage (ICH).
  • Non-CSVD etiologies, including trauma, vascular malformations, and tumors, account for a significant portion of ICH cases but are less studied regarding bleeding risk factors.
  • Previous research has primarily compared HA- and CAA-related ICH, often excluding non-CSVD causes and limiting understanding of diverse ICH risk profiles.

Purpose of the Study:

  • To compare risk factors for spontaneous intracerebral hemorrhage (ICH) across different etiologies: hypertensive arteriopathy (HA), cerebral amyloid angiopathy (CAA), and non-CSVD causes.
  • To investigate the prevalence of demographic factors, antithrombotic medication use, vascular risk profiles, and cerebral small-vessel disease (CSVD) severity in patients with ICH from various causes.
  • To provide a comprehensive analysis of factors contributing to ICH beyond the primary pathology, particularly in non-CSVD cases.

Main Methods:

  • A retrospective observational study involving 922 patients diagnosed with ICH.
  • Screening of medical records for 861 patients to gather data on demographics, antithrombotic medication, and vascular risk factors.
  • Assessment of cerebral small-vessel disease (CSVD) severity using magnetic resonance imaging (MRI) in 185 patients, with a sum score of ≥2 indicating advanced pathology.

Main Results:

  • Of 922 ICH patients, 73% were attributed to HA or CAA, and 27% to non-CSVD causes; median age was 71 years.
  • Patients with HA- and CAA-related ICH showed higher rates of advanced age, antithrombotic medication use, vascular risk factors, and advanced CSVD on MRI compared to non-CSVD ICH.
  • Notably, 50% of non-CSVD ICH patients exhibited risk factors such as age over 60, vascular risk factors, or advanced CSVD on MRI.

Conclusions:

  • While non-CSVD etiologies of ICH present with fewer risk factors than HA- or CAA-related ICH, these factors remain prevalent.
  • The findings underscore the importance of considering a broader range of risk factors, beyond the primary pathology, for accurate bleeding risk stratification in ICH patients.
  • Future research should integrate these additional factors to enhance the precision of individual risk assessment for spontaneous intracerebral hemorrhage.
Abstract

Keywords:
brain tumorcerebral amyloid angiopathycerebral small-vessel diseasehypertensionhypertensive arteriopathyintracerebral hemorrhagetraumavascular malformation

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