Abstract 133: Cerebellar Hematoma Location: Implications for the Underlying Microangiopathy

Abstract

Background: Previous pathologic reports have suggested that the underlying vasculopathy in cerebellar intracerebral hemorrhage (ICH) patients may be related to the location of the bleed whithin the cerebellum. We sought to determine whether the location of hematoma in the cerebellum (deep and superficial regions) was suggestive of a particular hemorrhage-prone small vessel disease pathology (hypertensive vasculopathy or cerebral amyloid angiopathy, CAA). Methods: Consecutive cerebellar-ICH patients were recruited from January 1998 to January 2016. Based on data from pathologic reports, patients were divided according to the location of the primary cerebellar hematoma (superficial, Figure, panel A-B, blu circles in panel E vs deep, Figure, panel C-D, orange circles in panel E ). Location of cerebral microbleeds (CMB; strictly-lobar, strictly-deep and mixed-CMB) was evaluated on MRI. 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 superficial cerebellar-ICH patients (89% vs 65%, respectively; p<0.05). Among the 80 patients who underwent MRI, those with superficial cerebellar-ICH had higher prevalence of strictly lobar-CMB (46%) and lower prevalence of strictly deep or mixed-CMB (0%) compared to those with deep superficial cerebellar-ICH (6% and 54%, respectively). Presence of lacunes was significantly higher in deep cerebellar-ICH than superficial cerebellar-ICH (53 vs 21%, respectively; p<0.05). In a multivariable model, presence of strictly lobar-CMB was associated with superficial cerebellar-ICH (OR: 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 CAA. Cerebellar hematoma location may thus help to identify those patients likely to have CAA pathology.