Racial differences in microbleed prevalence in primary intracerebral hemorrhage

Copenhaver, B. R.; Hsia, Amie W.; Merino, José G.; Burgess, Richard; Fifi, Johanna T; Davis, Lisa; Warach, Steve; Kidwell, Chelsea S.

doi:10.1212/01.wnl.0000327524.16575.ca

Cited by 54 publications

(38 citation statements)

References 21 publications

(24 reference statements)

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“…In multivariable analyses adjusting for ICH risk factors, NHPI race was an independent predictor of young ICH. The age disparity seen in our study is similar to the age disparities reported in other ICH observational studies comparing non-Hispanic white subjects to Maoris from New Zealand, 20 Mexican Americans, 21 and black patients 22,23 with ICH, and supports the idea that minority racial groups have a significantly younger age at presentation with ICH. Since NHPI have been historically grouped with Asians into a single racial category in many studies, prior ICH studies may have masked substantial differences in disease characteristics and outcomes among the NHPI group.…”

Section: Discussionsupporting

confidence: 89%

Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage

Nakagawa

Koenig²,

Seto³

et al. 2012

Neurology

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Objectives: To evaluate disparities in stroke risk factors and outcome among the Native Hawaiians and other Pacific Islanders (NHPI) in Hawaii who are hospitalized with intracerebral hemorrhage (ICH). Methods:We performed a retrospective study on consecutive patients hospitalized for acute ICH at a single tertiary center on Oahu between 2004 and 2010. Clinical data were obtained from the Get With the Guidelines-Stroke database. Multivariable logistic regression was used to assess the predictors for young ICH (age Ͻ45).Results: A total of 562 patients hospitalized for acute ICH (Asian 63%, NHPI 18%, white 16%, other 3%) were studied. The NHPI were younger (mean ages, NHPI 55 Ϯ 16 vs white 66 Ϯ 16 years, p Ͻ 0.0001), and had higher prevalence of diabetes (NHPI 35% vs white 20%, p ϭ 0.01) and history of hypertension (NHPI 77% vs white 64%, p ϭ 0.04) compared to white patients. Independent predictors for young ICH were NHPI race (odds ratio [OR] Conclusions: NHPI with ICH are younger and have higher burden of risk factors compared to white patients. Further studies controlling for socioeconomic modifiers are needed to determine factors contributing to the younger age at presentation in this racial group. Neurology ® 2012;79:675-680 GLOSSARY BMI ϭ body mass index; CAD ϭ coronary artery disease; CI ϭ confidence interval; GWTG ϭ Get With the Guidelines; HDL ϭ high-density lipoprotein; ICH ϭ intracerebral hemorrhage; IVH ϭ intraventricular hemorrhage; LDL ϭ low-density lipoprotein; LOS ϭ length of stay; MI ϭ myocardial infarction; NHPI ϭ Native Hawaiians and other Pacific Islanders; OR ϭ odds ratio; QMC ϭ Queen's Medical Center.Intracerebral hemorrhage (ICH) accounts for 10%-15% of the approximately 700,000 annual strokes in the Unites States 1 and results in disproportionately high morbidity and mortality. 2 In Hawaii, the age-adjusted incidence of ICH is estimated to be 0.6/1,000 person-years 3 in a population that consists of 25% white subjects, 39% Asians, and 10% Native Hawaiians and other Pacific Islanders (NHPI) compared to 0.3/1,000 person-years in a population in Northern Manhattan that consists of 23% white subjects, 12% black subjects, and 65% Hispanic subjects. 4 Recent evidence suggests that the burden of ICH is not borne equally by all, with racial minority groups reported to have a higher incidence and poorer outcomes than white subjects. [5][6][7] Although NHPI have been reported to have higher prevalence of major cardiovascular risk factors 8 -13 and die at a younger age from various cardiovascular diseaserelated complications compared to other major racial-ethnic groups, 14,15 the specific disease burden related to ICH in this population has not been studied. We hypothesized that NHPI with ICH are younger and have higher burden of risk factors compared to non-Hispanic white subjects.

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Section: Discussionsupporting

confidence: 89%

Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage

Nakagawa

Koenig²,

Seto³

et al. 2012

Neurology

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“…A ring hemorrhage is remote hemorrhagic lesion in ICH that is observed extensively in peripheral tissues around hematomas (Treip 1978;Copenhaver et al 2008;Imaizumi et al 2008;Smith et al 2010). Some ring hemorrhages have aspects of CMBs on MRI images.…”

Section: Discussionmentioning

confidence: 99%

Intracerebral Hematoma Extends via Perivascular Spaces and Perineurium

Yin

Lü

Qiu

et al. 2013

Tohoku J. Exp. Med.

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Intracerebral hemorrhage (ICH) is a devastating disorder associated with high morbidity and mortality. ICH results in the formation of hematoma that affects not only the primary site of injury but also the remote regions. In fact, hematoma can extend via perivascular spaces (also called Virchow-Robin spaces, VRS) and perineurium in an animal model of ICH. In the present study, we used magnetic resonance imaging (MRI) with susceptibility-weighted imaging (SWI) to investigate the characteristics of the perivascular and perineural extensions of hematomas in patients with ICH. A total of 20 ICH patients without secondary subarachnoid and secondary intraventricular hemorrhages were recruited. Brain MRI scans, including SWI, T1, and T2-weighted images, were performed between 17 h to 7 days after the onset of ICH. MRI with SWI revealed that paramagnetic substances spread along the VRS or the perineurium. Such distribution could cause the formation of cerebral microbleeds (CMBs). However, the distribution of remote hemorrhagic lesions varied, depending on the size and location of the original hematoma. The unenhanced CT scans of the 20 patients did not show any hyperdensity around the blood vessels and nerve tracts outside the hematoma. These results indicate the perivascular and perineural extensions of hematomas in patients with ICH, which is formed by the leakage of the original hematoma via the VRS or perineurium. We also provide a new explanation for the series of pathological processes involved in ICH, including the remote effects of hematoma and the formation of CMBs in patients with ICH.

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“…This hypothesis is supported by prior studies, including one from the ERICH cohort, demonstrating a greater burden of microbleeds and white matter hyperintensities in black and Hispanic participants with ICH compared with non-Hispanic white participants. 31,32 The association with younger age is counterintuitive and requires confirmation and further exploration in future studies. In our analysis, it is not explained by illicit drug use or performance of diagnostic angiography, both of which did not differ between groups.…”

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confidence: 96%

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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Racial differences in microbleed prevalence in primary intracerebral hemorrhage

Cited by 54 publications

References 21 publications

Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage

Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage

Intracerebral Hematoma Extends via Perivascular Spaces and Perineurium

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

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