Acute ischaemic lesions are associated with cortical superficial siderosis in spontaneous intracerebral hemorrhage

Revel-Mouroz, Paul; Viguier, Alain; Cazzola, Vanessa; Calvière, Lionel; Patsoura, Sofia; Rousseau, Vanessa; Sommet, Agnès; Albucher, Jean‐François; Cognard, Christophe; Olivot, Jean Marc; Bonneville, Fabrice; Raposo, Nicolas

doi:10.1111/ene.13874

Cited by 12 publications

(10 citation statements)

References 28 publications

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“…MR images were acquired on 1.5-T or 3-T scanners and included at least T2 * -weighted gradient recalled echo (T2 * -GRE) and axial fluid-attenuated inversion recovery (FLAIR) sequences, as previously described (11). Among the 260 patients with CMB included in the analysis, 148 (56.9%) underwent a 3-T MRI and 112 (43.1%) a 1.5-T MRI.…”

Section: Methodsmentioning

confidence: 99%

Underlying Small Vessel Disease Associated With Mixed Cerebral Microbleeds

et al. 2019

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Background and Purpose: Whether patients with both lobar and deep cerebral microbleeds (mixed CMB) have advanced cerebral amyloid angiopathy (CAA), hypertensive angiopathy (HA) or both is uncertain. To get insight into the underlying small vessel disease (SVD) associated with mixed CMB, we explored its association with cortical superficial siderosis (cSS), a key marker of CAA and other MRI markers of SVD in patients with intracerebral hemorrhage (ICH).Methods: Of 425 consecutive patients with acute ICH who had received brain MRIs, 260 had ≥1 CMB and were included in the analysis. They were categorized as strictly lobar CMB (suggesting CAA), strictly deep CMB (suggesting HA) or mixed CMB. Clinical and imaging characteristics were compared (1) between the three CMB groups and (2) within mixed CMB patients according to the symptomatic ICH location.Results: Overall, 111 (26%) patients had mixed CMB. Compared to strictly lobar CMB (n = 111) and strictly deep CMB (n = 38), patients with mixed CMB had a more severe burden of lacune, white matter hyperintensities and CMB. cSS was observed in 24.3% of patients with mixed CMB compared to 44.1% in strictly lobar CMB and 10.5% in strictly deep CMB (p < 0.0001). Among patients with mixed CMB, 44 (39.6%) had a lobar symptomatic ICH and 67 (60.4%) had a non-lobar ICH. Patients with non-lobar ICH were more likely to have hypertension, whereas those with lobar ICH were more likely to have cSS and chronic lobar ICH and had higher ratio lobar CMB count/total CMB count.Conclusions: Mixed CMB is frequently encountered in patients with ICH and appears as a heterogeneous group, suggesting that both CAA and HA may be contributing to mixed CMB. Neuroimaging markers including ICH location, cSS, and CMB distribution may indicate the predominant underlying vasculopathy, with potential prognostic implications.

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Section: Methodsmentioning

confidence: 99%

Underlying Small Vessel Disease Associated With Mixed Cerebral Microbleeds

et al. 2019

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“…We found a RDWIL prevalence of 23.5%, slightly higher than the 19% reported in a landmark 2019 meta-analysis, 3 reflecting the inclusion of recent prospective studies. 2,[4][5][6][7]10,22 We also report novel associations that provide insight into potential mechanisms underlying RDWILs. According to our meta-analysis, RDWILs are frequently observed in the first 48 hours, but new RDWILs may still be detected beyond day 7 and as late as 1 month, 13,17 implying they result from an ongoing process, namely cerebral small vessel disease.…”

Section: Rdwil Number and Locationmentioning

confidence: 71%

“…RDWILs were multiple in 68.8% patients (mean: 3.8) and contralateral to the ICH in 46.4%, mostly located within the cortex or subcortically (52.2% and 51.9% respectively; Table S5). 1,2,10,12,13,15,17,19–21…”

Section: Resultsmentioning

confidence: 99%

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Remote Diffusion-Weighted Imaging Lesions and Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Posener

Hmeydia

Benzakoun

et al. 2023

Stroke

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BACKGROUND: Remote diffusion-weighted imaging lesions (RDWILs) in the context of spontaneous intracerebral hemorrhage (ICH) are associated with an increased risk of recurrent stroke, worse functional outcome, and death. To update current knowledge on RDWILs, we conducted a systematic review and meta-analysis of the prevalence, associated factors and presumed causes of RDWILs. METHODS: We searched Pubmed, Embase, and Cochrane up to June 2022 for studies reporting RDWILs in adults with symptomatic ICH of no-identified-cause, assessed by magnetic resonance imaging, and analyzed associations between baseline variables and RDWILs in random-effects meta-analyses. RESULTS: Eighteen observational studies (7 prospective), reporting 5211 patients were included, of whom 1386 had ≥1 RDWIL (pooled prevalence: 23.5% [19.0–28.6]). RDWIL presence was associated with neuroimaging features of microangiopathy, atrial fibrillation (odds ratio, 3.67 [1.80–7.49]), clinical severity (mean difference in National Institutes of Health Stroke Scale score, 1.58 points [0.50–2.66]), elevated blood pressure (mean difference, 14.02 mmHg [9.44–18.60]), ICH volume (mean difference, 2.78 mL [0.97–4.60]), and subarachnoid (odds ratio, 1.80 [1.00–3.24]) or intraventricular (odds ratio, 1.53 [1.28–1.83]) hemorrhage. RDWIL presence was associated with poor 3-month functional outcome (odds ratio, 1.95 [1.48–2.57]). CONCLUSIONS: RDWILs are detected in approximately 1-in-4 patients with acute ICH. Our results suggest that most RDWILs result from disruption of cerebral small vessel disease by ICH-related precipitating factors such as elevated intracranial pressure and cerebral autoregulation impairment. Their presence is associated with worse initial presentation and outcome. However, given the mostly cross-sectional designs and heterogeneity in study quality, further studies are needed to investigate whether specific ICH treatment strategies may reduce the incidence of RDWILs and in turn improve outcome and reduce stroke recurrence.

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“…IRIS is a condition that occurs in immunosuppression or AIDS cases. The immune system recovers after treatment, but then responds to previously acquired opportunistic infections with an overwhelming inflammatory response that paradoxically makes the symptoms of infection worse (12). The mechanism of IRIS is thought to be due to a switch from following initiation therapy from a predominantly Th2 immune response (anti-inflammatory) to a Th1 or proinflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Immune Reconstitution Inflammatory Syndrome Secondary to Autoimmune Hemolytic Anemia and Cryptococcal Meningitis

Yin

Huang

et al. 2019

Front. Neurol.

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A 47-year-old HIV-seronegative woman with autoimmune hemolytic anemia (AIHA) was treated with corticosteroids for 8 months. She developed central nervous system dysfunction and was diagnosed with cryptococcal meningitis (CM) after detecting cryptococcus neoformans in the cerebrospinal fluid. The patient's clinical symptoms were worsened and unusual MRI findings of white matter lesions were noticed even after adequate treatment, which were quite unusual compared with typical characteristics of CM. This led us to carry out further investigations. Similar cases have been reported previously in published literature. Combined with clinical symptoms and MRI findings, the most likely diagnosis was Cryptococcal Meningitis-Immune Reconstitution Inflammatory Syndrome. Unfortunately, the patient deteriorated and died of respiratory failure. Cryptococcal Meningitis-Immune Reconstitution Inflammatory Syndrome may have MRI changes during the early onset of the disease (bilateral basal ganglia). We propose that close monitoring of the condition, meticulous MRI follow-up and brain biopsies should be indicated in such cases for treating them actively, so as to avoid worsening of the patients' condition.

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Acute ischaemic lesions are associated with cortical superficial siderosis in spontaneous intracerebral hemorrhage

Cited by 12 publications

References 28 publications

Underlying Small Vessel Disease Associated With Mixed Cerebral Microbleeds

Underlying Small Vessel Disease Associated With Mixed Cerebral Microbleeds

Remote Diffusion-Weighted Imaging Lesions and Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Immune Reconstitution Inflammatory Syndrome Secondary to Autoimmune Hemolytic Anemia and Cryptococcal Meningitis

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