Cerebellar Hematoma Location Implications for the Underlying Microangiopathy

被引:49
作者
Pasi, Marco [1 ]
Marini, Sandro [1 ,2 ]
Morotti, Andrea [4 ]
Boulouis, Gregoire [5 ]
Xiong, Li [1 ]
Charidimou, Andreas [1 ]
Ayres, Alison M. [1 ]
Lee, Myung Joo [1 ]
Biffi, Alessandro [3 ]
Goldstein, Joshua N. [2 ]
Rosand, Jonathan [2 ]
Gurol, M. Edip [1 ]
Greenberg, Steven M. [1 ]
Viswanathan, Anand [1 ]
机构
[1] Harvard Med Sch, Dept Neurol, Hemorrhag Stroke Res Program, Massachusetts Gen Hosp,Stroke Res Ctr, Boston, MA USA
[2] Harvard Med Sch, Div Neurocrit Care & Emergency Neurol, Massachusetts Gen Hosp, Boston, MA USA
[3] Harvard Med Sch, Div Behav Neurol, Dept Neurol, Massachusetts Gen Hosp, Boston, MA USA
[4] C Mondino Natl Neurol Inst, Stroke Unit, Pavia, Italy
[5] Univ Paris 05, Ctr Hosp St Anne, INSERM, Dept Neuroradiol,UMR 894, Paris, France
基金
美国国家卫生研究院;
关键词
cerebellum; cerebral amyloid angiopathy; hypertension; CEREBRAL AMYLOID ANGIOPATHY; PERIVASCULAR SPACES; HEMORRHAGE; MICROBLEEDS; DIAGNOSIS;
D O I
10.1161/STROKEAHA.117.019286
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Spontaneous cerebellar intracerebral hemorrhage (ICH) has been reported to be mainly associated with vascular changes secondary to hypertension. However, a subgroup of cerebellar ICH seems related to vascular amyloid deposition (cerebral amyloid angiopathy). We sought to determine whether location of hematoma in the cerebellum (deep and superficial regions) was suggestive of a particular hemorrhage-prone small-vessel disease pathology (cerebral amyloid angiopathy or hypertensive vasculopathy). Methods-Consecutive patients with cerebellar ICH from a single tertiary care medical center were recruited. Based on data from pathological reports, patients were divided according to the location of the primary cerebellar hematoma (deep versus superficial). Location of cerebral microbleeds (CMBs; strictly lobar, strictly deep, and mixed CMB) was evaluated on magnetic resonance imaging. Results-One-hundred and eight patients (84%) had a deep cerebellar hematoma, and 20 (16%) a superficial cerebellar hematoma. Hypertension was more prevalent in deep than in patients with superficial cerebellar ICH (89% versus 65%, respectively; P<0.05). Among patients who underwent magnetic resonance imaging, those with superficial cerebellar ICH had higher prevalence of strictly lobar CMB (43%) and lower prevalence of strictly deep or mixed CMB (0%) compared with those with deep superficial cerebellar ICH (6%, 17%, and 38%, respectively). In a multivariable model, presence of strictly lobar CMB was associated with superficial cerebellar ICH (odds ratio, 3.8; 95% confidence interval, 1.5-8.5; P=0.004). Conclusions-Our study showed that superficial cerebellar ICH is related to the presence of strictly lobar CMB-a pathologically proven marker of cerebral amyloid angiopathy. Cerebellar hematoma location may thus help to identify those patients likely to have cerebral amyloid angiopathy pathology.
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页码:207 / +
页数:13
相关论文
共 18 条
[1]   Cerebral Microbleeds, Vascular Risk Factors, and Magnetic Resonance Imaging Markers: The Northern Manhattan Study [J].
Caunca, Michelle R. ;
Del Brutto, Victor ;
Gardener, Hannah ;
Shah, Nirav ;
Dequatre-Ponchelle, Nelly ;
Cheung, Ying Kuen ;
Elkind, Mitchell S. V. ;
Brown, Truman R. ;
Cordonnier, Charlotte ;
Sacco, Ralph L. ;
Wright, Clinton B. .
JOURNAL OF THE AMERICAN HEART ASSOCIATION, 2016, 5 (09)
[2]   MRI-visible perivascular spaces in cerebral amyloid angiopathy and hypertensive arteriopathy [J].
Charidimou, Andreas ;
Boulouis, Gregoire ;
Pasi, Marco ;
Auriel, Eitan ;
van Etten, Ellis S. ;
Haley, Kellen ;
Ayres, Alison ;
Schwab, Kristin M. ;
Martinez-Ramirez, Sergi ;
Goldstein, Joshua N. ;
Rosand, Jonathan ;
Viswanathan, Anand ;
Greenberg, Steven M. ;
Gurol, M. Edip .
NEUROLOGY, 2017, 88 (12) :1157-1164
[3]   Cortical superficial siderosis: detection and clinical significance in cerebral amyloid angiopathy and related conditions [J].
Charidimou, Andreas ;
Linn, Jennifer ;
Vernooij, Meike W. ;
Opherk, Christian ;
Akoudad, Saloua ;
Baron, Jean-Claude ;
Greenberg, Steven M. ;
Jaeger, Hans Rolf ;
Werring, David J. .
BRAIN, 2015, 138 :2126-2139
[5]  
FAZEKAS F, 1987, AM J NEURORADIOL, V8, P421
[6]   ACUTE HYPERTENSIVE CEREBELLAR HEMORRHAGE - DIAGNOSIS AND SURGICAL-TREATMENT [J].
FISHER, CM ;
PICARD, EH ;
POLAK, A ;
DALAL, P ;
OJEMANN, RG .
JOURNAL OF NERVOUS AND MENTAL DISEASE, 1965, 140 (01) :38-57
[7]   Cerebral microbleeds: a guide to detection and interpretation [J].
Greenberg, Steven M. ;
Vernooij, Meike W. ;
Cordonnier, Charlotte ;
Viswanathan, Anand ;
Salman, Rustorn Al-Shahi ;
Warach, Steven ;
Launer, Lenore J. ;
Van Buchem, Mark A. ;
Breteler, Monique M. B. .
LANCET NEUROLOGY, 2009, 8 (02) :165-174
[8]   The Microbleed Anatomical Rating Scale (MARS) Reliability of a tool to map brain microbleeds [J].
Gregoire, S. M. ;
Chaudhary, U. J. ;
Brown, M. M. ;
Yousry, T. A. ;
Kallis, C. ;
Jaeger, H. R. ;
Werring, D. J. .
NEUROLOGY, 2009, 73 (21) :1759-1766
[9]   Management of Intracerebral Hemorrhage [J].
Gurol, Mahmut Edip ;
Greenberg, Steven M. .
CURRENT ATHEROSCLEROSIS REPORTS, 2008, 10 (04) :324-331
[10]   CEREBRAL AMYLOID ANGIOPATHY - A SIGNIFICANT CAUSE OF CEREBELLAR AS WELL AS LOBAR CEREBRAL-HEMORRHAGE IN THE ELDERLY [J].
ITOH, Y ;
YAMADA, M ;
HAYAKAWA, M ;
OTOMO, E ;
MIYATAKE, T .
JOURNAL OF THE NEUROLOGICAL SCIENCES, 1993, 116 (02) :135-141