Highlights
- •High-degree CSO-PVS was highly prevalent in probable cerebral amyloid angiopathy and was related to the cerebral superficial siderosis presence and cerebral microbleeds count.
- •Disseminated CSS was associated with recurrent ICH in CAA.
- •This data might be a help to decide whether or not to use the antithrombotic agent in the hemorrhagic stroke patients with high risk of ischemic stroke.
- •CSO-PVS could provide a good clue to modify the diagnostic criteria of CAA.
Abstract
Background
There is no doubt that cerebral amyloid angiopathy (CAA) is a key risk factor for
recurrent lobar ICH, however, the exact mechanism and interaction with MRI markers
of disease severity are less well known. Centrum semiovale-perivascular spaces (CSO-PVS)
have been suggested as adjunctive diagnostic criteria in order to enhance diagnostic
power. The purposes of this study were to investigate the prevalence of CSO-PVS and
its association with other imaging signatures {lobar microbleeds (CMB), cortical superficial
siderosis (CSS), white matter hyperintensity (WMH)} in lobar ICH patients as well
as recurrent lobar ICH risk, especially in patients taking antithrombotic agents.
Methods
This retrospective study included 85 patients who visited our institute between 2005
and 2013 with lobar ICH on magnetic resonance imaging(MRI). CSO-PVS were rated on
axial T2-weighted sequences using a validated 2-point visual rating scale (high degree
>20, low degree ≤20). The CSS, CMB and WMH were also evaluated. The relationship between CSO-PVS, CSS,
CMB, antithrombotic usage and recurrent bleeding were explored.
Results
A high degree of CSO-PVS was present in 71.8% of patients. The prevalence of CSS and
CMB was higher in patients with a high degree of CSO-PVS (CSS, 49.2% vs. 16.7%, P = 0.006; CMB count, 7.3% vs. 2.1%, P = 0.002). A high degree of CSO-PVS and antithrombotic usage following lobar ICH was
not associated with recurrent hemorrhage. In multivariate logistic regression analysis
of predictors of recurrent lobar ICH in lobar ICH patients, post-ICH antithrombotics
use and disseminated CSS are independently associated with increased risk of recurrent
lobar ICH.
Conclusions
High-degree CSO-PVS is highly prevalent in probable cerebral amyloid angiopathy and
is related to CSS and CMB. Disseminated CSS was associated with recurrent ICH in CAA.
Our study might help physicians decide whether or not to use antithrombotic agents
in hemorrhagic stroke patients with a high risk of ischemic stroke. A large prospective
study is warranted to validate these findings.
Abbreviations:
CAA (cerebral amyloid angiopathy), ICH (intracerebral hemorrhage), CSO-PVS (centrum semiovale-perivascular spaces), CSS (cortical superficial siderosis), CMB (cortical microbleed)Keywords
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References
- Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum.J. Neurol. Neurosurg. Psychiatry. 2012; 83: 124-137
- Advances in the management of intracerebral hemorrhage.J. Neural Transm. 2013; 120: S35-S41
- Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria.Neurology. 2001; 56: 537-539
- Prevalence and mechanisms of cortical superficial siderosis in cerebral amyloid angiopathy.Neurology. 2013; 81: 626-632
- White matter perivascular spaces: an MRI marker in pathology-proven cerebral amyloid angiopathy?.Neurology. 2014; 82: 57-62
- Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy.Neurology. 2010; 74: 1346-1350
- White matter perivascular spaces are related to cortical superficial siderosis in cerebral amyloid angiopathy.Stroke. 2014; 45: 2930-2935
- Cortical superficial siderosis: detection and clinical significance in cerebral amyloid angiopathy and related conditions.Brain. 2015; 138: 2126-2139
- Enlarged perivascular spaces as a marker of underlying arteriopathy in intracerebral haemorrhage: a multicentre MRI cohort study.J. Neurol. Neurosurg. Psychiatry. 2013; 84: 624-629
- Topography of dilated perivascular spaces in subjects from a memory clinic cohort.Neurology. 2013; 80: 1551-1556
- Aspirin for secondary prevention after stroke of unknown etiology in resource-limited settings.Neurology. 2014; 83: 1004-1011
- Cerebral amyloid angiopathy causing cortical microinfarction.J. Clin. Neurosci. 2013; 20: 1802-1804
- Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension.Arch. Neurol.-Chicago. 1995; 52: 702-708
- Ischemic brain injury in cerebral amyloid angiopathy.J. Cereb. Blood Flow Metab. 2015;
- Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy.Neurology. 2009; 72: 1230-1235
- Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration.Lancet Neurol. 2013; 12: 822-838
- The Microbleed Anatomical Rating Scale (MARS) reliability of a tool to map brain microbleeds.Neurology. 2009; 73: 1759-1766
- Risk of rapid global functional decline in elderly patients with severe cerebral age-related white matter changes: the LADIS study.Arch. Intern. Med. 2007; 167: 81-88
- Topography and associations of perivascular spaces in healthy adults the Kashima scan study.Neurology. 2014; 83: 2116-2123
- Developmental aspects of the intracerebral microvasculature and perivascular spaces: insights into brain response to late-life diseases.J. Neuropathol. Exp. Neur. 2011; 70: 1060-1069
- Perivascular drainage of amyloid-beta peptides from the brain and its failure in cerebral amyloid angiopathy and Alzheimer's disease.Brain Pathol. 2008; 18: 253-266
- Prevalence and risk factors of cerebral microbleeds an update of the Rotterdam scan study.Stroke. 2010; 41: S103-S106
- Cerebral microbleeds: a guide to detection and interpretation.Lancet Neurol. 2009; 8: 165-174
- Spatial relation between microbleeds and amyloid deposits in amyloid angiopathy.Ann. Neurol. 2010; 68: 545-548
- Antiplatelet use after intracerebral hemorrhage.Neurology. 2006; 66: 206-209
- Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy.Neurology. 2010; 75: 693-698
Article info
Publication history
Published online: May 20, 2016
Accepted:
May 19,
2016
Received in revised form:
April 26,
2016
Received:
September 1,
2015
Identification
Copyright
© 2016 Published by Elsevier B.V.
