Abstract WP440: Pre-existing Cerebral Atrophy is Associated With Diminished Intracerebral Hemorrhage Severity

Abstract

Background and Objective: Cerebral small vessel disease (CSVD) is a chronic, cumulative cerebrovascular disease and is the most common cause of intracerebral hemorrhage (ICH). The effects of pre-existing CSVD on the severity of acute ICH are incompletely understood. We aim to clarify associations between computed tomography (CT) markers of CSVD and 1) acute ICH volume and 2) presence and severity of concomitant intraventricular hemorrhage (IVH). Methods: Baseline CT scans of patients from the Ethnic and Racial Variations of Intracerebral Hemorrhage (ERICH) study were evaluated for the extent of leukoaraiosis and cerebral atrophy using visual rating scales and for the Graeb Score, as a measure of IVH severity. ICH volume was measured on baseline CT scans using semi-automated software. The associations of leukoaraiosis and atrophy and ICH volume, IVH presence and the Graeb Score were tested using multivariable linear, ordinal and binary logistic regression models. Secondary analyses were stratified by hemorrhage location (lobar versus non-lobar). Bonferroni correction was applied. Results: The study included 2579 patients, 774 (30.0%) with a lobar ICH and 1805 (70.0%) with a non-lobar ICH. Median ICH volume was higher for lobar ICH and non-lobar ICH was more frequently associated with IVH. Increasing grades of central, cortical and total atrophy were inversely and dose-dependently associated with baseline ICH volume (P for trend <0.001). Leukoaraiosis was not significantly associated with ICH volume in multivariable analysis. Leukoaraiosis was associated with increased risk of IVH in a dose-dependent manner (P for trend <0.001), while global atrophy was inversely associated with IVH presence and severity (both P for trend <0.001). Analyses stratified by ICH location revealed largely similar associations for non-lobar and lobar ICH. Conclusions: In this study, increasing grades of cerebral atrophy were associated with smaller ICH volume and decreased risk of IVH presence and severity, while increasing extent of leukoaraiosis was associated with higher risk of IVH. These findings suggest that cerebral atrophy might be protective in the setting of acute ICH. Future studies are needed to confirm our findings and identify the underlying mechanisms.