Risk Profile of Symptomatic Lacunar Stroke Versus Nonlobar Intracerebral Hemorrhage

Abstract

T he term cerebral small vessel disease (SVD) encompasses a wide spectrum of pathological processes affecting the small vessels of the brain, 1 among which, arteriolosclerosis, also known as hypertensive microangiopathy, is the most common. Lacunar strokes (LS) and hemorrhages located in the deep brain regions (nonlobar or deep intracerebral hemorrhage [dICH]) represent the acute symptomatic consequences of this progressive microangiopathy. Because these two phenotypes share the same pathological substrate, 1 it is still matter of debate why some individuals are more prone to develop acute small vessel occlusion, whereas others are more susceptible to vascular rupture. To date, few studies have attempted to address this issue, with conflicting results. Most of the inconsistency arise from methodological drawbacks of the study designs, including the relatively small number of subjects in some analyses, the exclusion of subjects without hypertension in others, as well as the lack of a clear distinction between ischemic stroke subtypes and between lobar and dICH.2-5 Therefore, in this study we aimed at investigating whether differences in individual risk factor profile underlie the propensity for developing dICH, rather than LS.Background and Purpose-Although lacunar stroke (LS) and deep intracerebral hemorrhage (dICH) represent acute manifestations of the same pathological process involving cerebral small vessels (small vessel disease), it remains unclear what factors predispose to one phenotype rather than the other at individual level. Methods-Consecutive patients with either acute symptomatic LS or dICH were prospectively enrolled as part of a multicenter Italian study. We compared the risk factor profile of the 2 subgroups using multivariable logistic regression.

Lacunar Infarcts and Intracerebral Hemorrhage Differences

“…It is possible that the micro- and macrovascular effects of diabetes constitute a critical mediator that, in the presence of hypertension, predisposes to a thrombogenic process. This finding is in accordance with prior studies 2 , but contradicts a recent study comparing iCH and LS cases where no difference in the prevalence of diabetes was found 5 .…”

Risk Profile of Ischemic Stroke Caused by Small-Artery Occlusion vs. Deep Intracerebral Hemorrhage

“…In our study, history of hypertension and the specific pressure values (SBP, DBP, PP, and MAP) played a dominant role in dICH, which favored previous findings (7, 8). Contrary to hypertension, diabetes mellitus was associated with SAO stroke, which was also consistent with previous reports (19–21).…”

“…However, SAO stroke and dICH represent opposite ends of the similar pathological process in cerebral small vessels. It was shown that patients with SAO were older and more likely to have diabetes mellitus and higher cholesterol level, while dICH patients tended to be excessive alcohol consumers and have hypertension (7, 8). However, controversy still remained on other risk factors for cerebrovascular disease.…”

Hypercholesterolemia induced cerebral small vessel disease

“…The pathological changes of small arteries and capillaries are defined as cerebral small vessel disease (CSVD), characterized by age-dependent blood-brain barrier (BBB) breakdown and arteriolosclerosis leading to small vessel occlusions, microbleeds and lacunar infarctions [ 5 – 7 ]. Recent human cohort studies using magnetic resonance imaging (MRI) challenged the specific associations between lacunar infarct development and hypercholesterolemia [ 8 – 10 ]. Furthermore, other studies claimed protective effects of hypercholesterolemia preventing from CSVD-related downstream microangiopathic lesions [ 11 – 12 ].…”