Enlarged perivascular spaces and small diffusion-weighted lesions in intracerebral hemorrhage

Wu, Bo; Yao, Xiaoying; Lei, Chunyan; Liu, Ming; Selim, Magdy

doi:10.1212/wnl.0000000000002169

Cited by 48 publications

(67 citation statements)

References 28 publications

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“…In our cohort, we observed acute ischaemic lesions among 15.5% of patients with acute ICH within 10 days after symptom onset. These results are in line with the prevalence reported in previous studies, ranging from 11% to 41% . As previously described, we found that patients with lobar ICH more frequently had DWI lesions than those with deep ICH .…”

Section: Discussionsupporting

confidence: 93%

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

Revel-Mouroz

Viguier

Cazzola

et al. 2018

Euro J of Neurology

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Background and purpose Diffusion‐weighted imaging (DWI) commonly detects acute ischaemic lesions in patients with acute intracerebral hemorrhage (ICH), especially with cerebral amyloid angiopathy (CAA). We investigated the relationship between cortical superficial siderosis (cSS), a neuroimaging marker of CAA, and DWI lesions in patients with acute ICH. Methods We conducted a retrospective analysis of prospectively collected data from consecutive patients with acute supratentorial ICH who underwent brain magnetic resonance imaging within 10 days after symptom onset. Magnetic resonance imaging scans were analyzed for DWI lesions, cSS and other markers for small‐vessel disease. Univariate and multivariate analyses were performed to assess the association between cSS and DWI lesions. Results Among 246 ICH survivors (mean age 71.4 ± 12.6 years) who were enrolled, 126 had lobar ICH and 120 had deep ICH. Overall, DWI lesions were observed in 38 (15.4%) patients and were more common in patients with lobar ICH than deep ICH (22.2% vs. 8.3%; P = 0.003). In multivariate logistic regression analysis, the extent of white matter hyperintensities [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.05–1.58; P = 0.02] and cSS severity (focal cSS: OR, 3.54; 95% CI, 1.28–9.84; disseminated cSS: OR, 4.41; 95% CI, 1.78–10.97; P = 0.001) were independently associated with the presence of DWI lesions. Conclusions Diffusion‐weighted imaging lesions are more frequently observed in patients with acute lobar ICH than in those with deep ICH. cSS severity and white matter hyperintensity extent are independent predictors for the presence of DWI lesions, suggesting that CAA may be involved in the pathogenesis of DWI lesions associated with acute ICH.

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Section: Discussionsupporting

confidence: 93%

“…The mechanisms and etiology of DWI lesions in patients with acute ICH remain uncertain. Previous studies have linked DWI lesions to underlying SVD . DWI lesions are more frequently observed in CAA‐ICH and are associated with markers of CAA including lobar CMB, WMHs and enlarged perivascular spaces in the centrum semiovale .…”

Section: Discussionmentioning

confidence: 99%

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

Revel-Mouroz

Viguier

Cazzola

et al. 2018

Euro J of Neurology

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“…As for EPVSs, Wu et al . using a cohort in America found that CSO‐EPVSs were significantly more prevalent in ICH patients with R‐DWILs than in those without and identified a trend between high basal ganglia EPVSs (BG‐EPVSs) and the presence of R‐DWILs . Conversely, a similar trend between BG‐EPVSs and the presence of R‐DWILs was not identified in this work.…”

Section: Discussioncontrasting

confidence: 65%

Association between remote diffusion‐weighted imaging lesions and cerebral small vessel disease in primary intracerebral hemorrhage

et al. 2019

Euro J of Neurology

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Background and purpose The aim of this study was to examine the association amongst remote diffusion‐weighted imaging lesions (R‐DWILs), imaging markers of cerebral small vessel disease (cSVD) and total cSVD burden in patients with primary intracerebral haemorrhage (ICH). Methods In total, 344 consecutive primary ICH patients were enrolled prospectively. R‐DWILs on magnetic resonance imaging as well as four imaging markers of cSVD, including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), lacunes and enlarged perivascular spaces, were rated with validated scales. The total cSVD score was calculated by adding up these four markers. Univariate and multivariate analyses were performed. Results Remote DWI lesions were detected in 57 (16.6%) primary ICH patients. On multivariate logistic regression analysis, the presence of CMBs [odds ratio (OR) 5.26, 95% confidence interval (CI) 1.72–16.12], of high‐grade WMHs (OR 4.68, 95% CI 2.01–10.90), the presence of lacunes (OR 2.69, 95% CI 1.20–6.06), mixed CMBs (OR 2.93, 95% CI 1.35–6.36), mixed lacunes (OR 3.60, 95% CI 1.25–10.37), periventricular WMHs (OR 2.19, 95% CI 1.40–3.44), deep WMHs (OR 1.92, 95% CI 1.24–2.97) and total WMHs (OR 1.52, 95% CI 1.20–1.94) were associated with the presence of R‐DWILs. A significant association was also found between high‐grade total cSVD score and R‐DWILs (OR 1.97, 95% CI 1.36–2.84). This association remained significant in patients stratified by an age of 60 years or more than 60 years. Conclusions Remote DWI lesions are correlated with the severity of each imaging marker of cSVD and with the total burden of cSVD.

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“…[5][6][7][8][9][10] Over the last several years, a growing number of studies have characterized the presence and frequency of ischemic lesions remote from the acute hematoma visualized on diffusion-weighted imaging (DWI) in patients with primary ICH undergoing MRI. [11][12][13][14][15][16][17][18][19] Across these series, remote DWI lesions are visualized in 11%-41% of patients. There have been conflicting reports of an association between DWI lesions and large fluctuations in BP in the acute hospital setting.…”

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confidence: 87%

“…Finally, one recent report linked DWI lesions to enlarged perivascular spaces, a variable that we did not evaluate. 19 However, compared to prior studies, strengths of this study include the large sample size, the multicenter, prospective study design, and inclusion of an equal number of participants from multiple races and ethnicities, particularly those at higher risk of ICH; these study design characteristics increase the generalizability of the study results compared to prior studies.…”

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confidence: 98%

Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

et al. 2017

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Objective: To evaluate the associations among diffusion-weighted imaging (DWI) lesions, blood pressure (BP) dysregulation, MRI markers of small vessel disease, and poor outcome in a large, prospective study of primary intracerebral hemorrhage (ICH). Methods:The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients.Results: Of 600 patients, mean (6SD) age was 60.8 6 13.6 years, median (interquartile range) ICH volume was 9.1 mL (3.5-20.8), and 79.6% had hypertension. Overall, 26.5% of cases had DWI lesions, and this frequency differed by race/ethnicity (black 33.8%, Hispanic 24.9%, white 20.2%, overall p 5 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721, p 5 0.002), higher first recorded systolic BP (10-unit OR 1.12, p 5 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10, p 5 0.037), microbleeds (OR 1.99, p 5 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16, p 5 0.002) after controlling for race/ethnicity, leukocyte count, and acute in-hospital antihypertensive treatment. A second model of variables associated with poor 90-day functional outcome (modified Rankin Scale scores 4-6) included DWI lesion count (OR 1.085, p 5 0.034) as well as age, ICH volume, intraventricular hemorrhage, Glasgow Coma Scale score, WMH score, race/ethnicity, acute in-hospital antihypertensive treatment, and ICH location. Conclusions:These results support the hypotheses that acute BP dysregulation is associated with the development of DWI lesions in primary ICH and that DWI lesions are, in turn, associated with poor outcomes. Neurology ® 2017;88:782-788 GLOSSARY ADC 5 apparent diffusion coefficient; BP 5 blood pressure; CAA 5 cerebral amyloid angiopathy; DWI 5 diffusion-weighted imaging; ERICH 5 Ethnic/Racial Variations of Intracerebral Hemorrhage; FLAIR 5 fluid-attenuated inversion recovery; GCS 5 Glasgow Coma Scale; GRE 5 gradient recalled echo; ICH 5 intracerebral hemorrhage; INTERACT2 5 Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage 2; IVH 5 intraventricular hemorrhage; MAP 5 mean arterial pressure; mRS 5 modified Rankin Scale; SBP 5 systolic blood pressure; SWI 5 susceptibility-weighted imaging; WMH 5 white matter hyperintensity.Primary intracerebral hemorrhage (ICH) is the second most common cause of stroke, affecting over 1 million people worldwide each year.1,2 ICH causes significantly greater morbidity and mortality than ischemic stroke. Hypertension is the most common risk factor for ICH. Elevated blood pressure (BP), often at extreme levels, frequently occurs in the hyperacute and acute phases of primary ICH and is associated with hemorrhage expansion and poor outcome. 3,4 Several recent trials have sought to determine whether intensive lowering of BP acutely improves outcomes in patients with ICH. 5-10Over the last several years, a growing number of studies have characte...

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Enlarged perivascular spaces and small diffusion-weighted lesions in intracerebral hemorrhage

Abstract: In our cohort, high EPVS, in particular CSO-EPVS, and larger hematoma volume emerged as independent predictors for SA-DWIL after ICH. Our findings might provide a new explanation for the pathophysiologic mechanisms predisposing to SA-DWIL after ICH.

Cited by 48 publications

References 28 publications

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

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

Association between remote diffusion‐weighted imaging lesions and cerebral small vessel disease in primary intracerebral hemorrhage

Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

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