Covert cerebral small vessel disease and outcomes after spontaneous intracerebral hemorrhage

The prognostic implications of covert cerebral small vessel disease (SVD) in spontaneous intracerebral hemorrhage (ICH) remain unclear. We investigated associations of SVD markers with hematoma severity and functional outcomes in patients with ICH. SVD markers (white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and cortical superficial siderosis [cSS]) were assessed. Outcomes included hematoma volume, hematoma expansion, and disability or death (mRS4-6 at 90 days and 1 year). Of 1660 patients who underwent MRI (mean age: 70 ± 13 years, 43% female), 397 had lobar (143 CAA-related) and 1263 had deep ICH. In lobar ICH, confluent WMH (β = -0.29, 95%CI -0.54 to -0.01) and mixed CMB (β = -0.72 [-1.02 to -0.42]) were associated with smaller hematoma volume, and cSS was associated with hematoma expansion (OR, 1.97 [1.03-3.79]). In deep ICH, confluent WMH (β = -0.25 [-0.41 to -0.09]), ⩾5 mixed CMBs (β = -0.17 [-0.34 to -0.01]), and lacune (β = -0.21 [-0.34 to -0.06]) were associated with smaller hematoma volume. Confluent WMH and mixed CMBs were also associated with poor functional outcome at 90 days (aOR 1.71 [1.16-2.51] and 1.52 [1.02-2.24]) and 1 year (aOR, 1.56 [1.06-2.23] and 1.42 [1.01-1.99]), and incorporating these markers into established risk factors improved discrimination for 1-year functional outcome. Similar findings were observed in ICH etiology. Covert SVD markers are associated with hematoma severity and functional outcomes after ICH.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT02251665.