Hypertensive Intracerebral Hemorrhage in the Very Elderly

Chiquete, Erwin; Ruiz-Sandoval, M. Carmen; Álvarez-Palazuelos, Lucía Elizabeth; Padilla-Martínez, Juan José; González-Cornejo, Salvador; Ruiz-Sandoval, José Luís

doi:10.1159/000104477

Cited by 28 publications

(29 citation statements)

References 50 publications

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“…36 Future studies directly investigating the relationship between thalamic FA changes and hemodynamic measures of cerebral blood flow (e.g., transcranial Doppler, perfusion MRI, or positron emission tomography) are needed to further support this conceptual link. However, the relatively frequent occurrence of hypertensive intracerebral hemorrhage in the thalamus of older subjects 37 indicates that the thalamus is especially vulnerable to vascular damage in an older population, similar in age range to the one we studied. Hence, the presence of thalamic damage may be a particularly sensitive indicator of more widespread cerebral SVD that leads to progression of WMHs.…”

Section: Discussionsupporting

confidence: 54%

Thalamic Fractional Anisotropy Predicts Accrual of Cerebral White Matter Damage in Older Subjects with Small-Vessel Disease

Cavallari

Moscufo

Meier

et al. 2014

J Cereb Blood Flow Metab

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White matter hyperintensities (WMHs) and lacunes are magnetic resonance imaging hallmarks of cerebral small-vessel disease, which increase the risk of stroke, cognitive, and mobility impairment. Although most studies of cerebral small-vessel disease have focused on white matter abnormalities, the gray matter (GM) is also affected, as evidenced by frequently observed lacunes in subcortical GM. Diffusion tensor imaging (DTI) is sensitive to subtle neurodegenerative changes in deep GM structures. We explored the relationship between baseline DTI characteristics of the thalamus, caudate, and putamen, and the volume and subsequent accrual of WMHs over a 4-year period in 56 community-dwelling older (X75 years) individuals. Baseline thalamic fractional anisotropy (FA) was an independent predictor of WMH accrual. WMH accrual also correlated with baseline lacune count and baseline WMH volume, the latter showing the strongest predictive power, explaining 27.3% of the variance. The addition of baseline thalamic FA in multivariate modeling increased this value by 70%, which explains 46.5% of the variance in WMH accrual rate. Thalamic FA might serve as a novel predictor of cerebral small-vessel disease progression in clinical settings and trials. Furthermore, our findings point to the possibility of a causal relationship between thalamic damage and the accrual of WMHs.

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Section: Discussionsupporting

confidence: 54%

Thalamic Fractional Anisotropy Predicts Accrual of Cerebral White Matter Damage in Older Subjects with Small-Vessel Disease

Cavallari

Moscufo

Meier

et al. 2014

J Cereb Blood Flow Metab

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“…5 In a recent publication, no significant difference in mortality rate for the geriatric patients with ICH compared with younger patients with ICH was observed in a small sample size. 8 In our data, we found significantly higher in-hospital mortality rates for patients with ICH Ն80 years compared with patients Ͻ80 years.…”

Section: Discussionsupporting

confidence: 47%

Intracerebral Hemorrhage in the Very Old

Stein

Misselwitz

Hamann

et al. 2012

Stroke

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Background and Purpose-In most European societies and in the United States, the percentage of patients Ն80 years has been rising over the past century. The present study was conducted to observe this demographic change and its impact on patients with intracerebral hemorrhage (ICH). Methods-We reviewed patients' data with the diagnosis of ICH from January 2007 to December 2009. All data were collected out of a prospective stroke registry covering the entire state of Hesse, Germany. Incidence rates and absolute numbers of patients with ICH for 2009 to 2050 were calculated. Results-Of 3448 patients, 34% had an age Ն80 years. Hospital mortality was 35.9% for patients Ն80 years and 20.0%for patients Ͻ80 years. Unfavorable outcome (modified Rankin Scale score Ͼ2) was more often found in patients Ն80 years compared with patients Ͻ80 years (84.9% versus 74.8%). By the year 2050, the proportion of all patients with ICH Ն80 years will be 2.5-fold higher than in 2009. The total number of ICH cases will increase approximately 35.2% assuming that ICH probability stays the same. The number of patients who die in the hospital will increase approximately 60.2%. The total number of patients with severe disability due to ICH will increase approximately 36.8%. Conclusions-If current treatment strategies according to age remain unchanged, an increase of in-hospital mortality and a higher proportion of patients who need lifelong care after ICH can be expected in the coming decades. (Stroke.

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“…Only 3 previous investigations compared ICH admission characteristics and mortality of oldest-old to those of younger patients [11][12][13] ; results are conflicting and only in-hospital mortality was investigated (online suppl. table 2 for a detailed summary).…”

Section: Discussionmentioning

confidence: 99%

“…table 2 for a detailed summary). The only investigation providing volumetric data is a case-control study of hypertensive patients [12] ; oldest-old did not differ from younger patients for hematoma volume but had higher IVH occurrence. Data reported as number (%) and OR (95% CI).…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Age on Characteristics and Mortality of Intracerebral Hemorrhage in the Oldest-Old

et al. 2016

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Background: Incidence of acute intracerebral hemorrhage (ICH) increases with age, but there is a lack of information about ICH characteristics in the oldest-old (age ≥85 years). In particular, there is a need for information about hematoma volume, which is included in most clinical scales for prediction of mortality in ICH patients. Many of these scales also assume that, independent of ICH characteristics, the oldest-old have a higher mortality than younger elderly patients (age 65-74 years). However, supporting evidence from cohort studies is limited. We investigated ICH characteristics of oldest-old subjects compared to young (<65 years), young-old (65-74 years) and old-old (75-84 years) subjects. We also investigated whether age is an independent mortality predictor in elderly (age ≥65 years) subjects with acute ICH. Methods: We retrospectively collected clinical and neuroimaging data of 383 subjects (age 34-104 years) with acute supratentorial primary ICH who were admitted to an Italian Stroke Unit (SU) between October 2007 and December 2014. Measured ICH characteristics included hematoma location, volume and intraventricular extension of hemorrhage on admission CT scan; admission Glasgow Coma Scale ≤8 and hematoma expansion (HE) measured on follow-up CT-scans obtained after 24 h. General linear models and logistic models were used to investigate the association of age with ICH characteristics. These models were adjusted for pre-admission characteristics, hematoma location and time from symptom onset to admission CT scan. Limited to elderly subjects, Cox models were used to investigate the association of age with in-SU and 1-year mortality: the model for in-SU mortality adjusted for pre-admission and ICH admission characteristics and the model for 1-year mortality additionally adjusted for functional status and disposition at SU discharge. Results: Independent of pre-admission characteristics, hematoma location and time from symptom onset to admission CT-scan, oldest-old subjects had the highest admission hematoma volume (p < 0.01). Age was unrelated to all other ICH characteristics including HE. In elderly patients, multivariable adjusted risk of in-SU and 1-year mortality did not vary across age categories. Conclusions: Oldest-old subjects with acute supratentorial ICH have higher admission hematoma volume than young and young-old subjects but do not differ for other ICH characteristics. When taking into account confounding from ICH characteristics, risk of in-SU and 1-year mortality in elderly subjects with acute supratentorial ICH does not differ across age categories. Our findings question use of age as an independent criterion for stratification of mortality risk in elderly subjects with acute ICH.

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Hypertensive Intracerebral Hemorrhage in the Very Elderly

Cited by 28 publications

References 50 publications

Thalamic Fractional Anisotropy Predicts Accrual of Cerebral White Matter Damage in Older Subjects with Small-Vessel Disease

Thalamic Fractional Anisotropy Predicts Accrual of Cerebral White Matter Damage in Older Subjects with Small-Vessel Disease

Intracerebral Hemorrhage in the Very Old

The Effect of Age on Characteristics and Mortality of Intracerebral Hemorrhage in the Oldest-Old

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