Differences in cerebral small vessel disease magnetic resonance imaging markers between lacunar stroke and non–Lobar intracerebral hemorrhage

Abstract

Introduction It is unclear why cerebral small vessel disease (SVD) leads to lacunar stroke in some and to non–lobar intracerebral hemorrhage (ICH) in others. We investigated differences in MRI markers of SVD in patients with lacunar stroke or non–lobar ICH. Patients and methods We included patients from two prospective cohort studies with either lacunar stroke (RUN DMC) or non–lobar ICH (FETCH). Differences in SVD markers (white matter hyperintensities [WMH], lacunes, cerebral microbleeds [CMB]) between groups were investigated with univariable tests; multivariable logistic regression analysis, adjusted for age, sex, and vascular risk factors; spatial correlation analysis and voxel–wise lesion symptom mapping. Results We included 82 patients with lacunar stroke (median age 63, IQR 57–72) and 54 with non-lobar ICH (66, 59–75). WMH volumes and distribution were not different between groups. Lacunes were more frequent in patients with a lacunar stroke (44% vs. 17%, adjusted odds ratio [aOR] 5.69, 95% CI [1.66–22.75]) compared to patients with a non–lobar ICH. CMB were more frequent in patients with a non–lobar ICH (71% vs. 23%, aOR for lacunar stroke vs non–lobar ICH 0.08 95% CI [0.02–0.26]), and more often located in non–lobar regions compared to CMB in lacunar stroke. Discussion Although we obserd different types of MRI markers of SVD within the same patient, ischemic markers of SVD were more frequent in the ischemic type of lacunar stroke, and hemorrhagic markers were more prevalent in the hemorrhagic phenotype of non-lobar ICH. Conclusion There are differences between MRI markers of SVD between patients with a lacunar stroke and those with a non-lobar ICH.

Small vessel disease burden and risk of recurrent cerebrovascular events in patients with lacunar stroke and intracerebral haemorrhage attributable to deep perforator arteriolopathy

“…We confirm the higher prevalence of CMBs in non-lobar ICH than in LS and the similar severity and distribution of white matter hyperintensities in these entities, which were reported in a previous study. 9 While Wiegertjes et al determined the severity of white matter hyperintensities using volumetry, 9 we applied the semiquantitative score by Fazekas et al, which is frequently used in clinical routine due to its straight-forward approach. 17 In contrast to previous work, 9 we found the prevalence of supratentorial and brainstem lacunes to be higher in deep ICH than in LS, which also contributes to the higher overall small vessel disease burden in deep ICH.…”

“…9 While Wiegertjes et al determined the severity of white matter hyperintensities using volumetry, 9 we applied the semiquantitative score by Fazekas et al, which is frequently used in clinical routine due to its straight-forward approach. 17 In contrast to previous work, 9 we found the prevalence of supratentorial and brainstem lacunes to be higher in deep ICH than in LS, which also contributes to the higher overall small vessel disease burden in deep ICH. While the prevalence of lacunes in ischaemic strokes is comparable to the one reported in literature, 22 the number of lacunes in deep ICH is higher than previously reported prevalences of around 20%.…”

“…8 Although deep ICH and lacunar strokes (LS) are both considered to be consequences of DPA, comparisons of clinical and imaging characteristics between the two manifestations are scarce. 9 However, additional knowledge on similarities and differences in risk factors and outcomes might help guide preventive treatment strategies and identify diverging risk profiles.…”

The association between blood pressure variability and perihematomal edema after spontaneous intracerebral hemorrhage

“…3 T brain MRI [Siemens Healthineers, Erlangen, Germany (Radboudumc); Philips Healthcare, Best, The Netherlands (LUMC, UMCU)] was performed using a standard protocol, amongst which Fluid Attenuated Inversion Recovery (FLAIR), and blood sensitive sequences (T2 * in Radboudumc and UMCU; susceptibility-weighted imaging (SWI) in LUMC) ( 29 ).…”

Cerebral small vessel disease and perihematomal edema formation in spontaneous intracerebral hemorrhage

“…The cerebral small vessel disease burden was rated by one trained rater, with a second rater assessing a random subsample, as previously described (26). Additionally, enlarged perivascular spaces (EPVS) were rated by a trained assessor (WJ), with a second rater (CK) assessing a random subsample of 10%.…”