Abstract
The relationship of white-matter hyperintensity (WMH) to intracerebral hemorrhage (ICH) remains unclear. In this retrospective study, we investigated whether the severity and progression of WMH could be related to the hematoma volume and absorption in ICH. 2338 WMH patients with ICH aged≥40 years receiving brain computed tomography (CT) imaging within 12 hours of ICH symptom onset were screened, and 227 patients were included in the final study. The severity and progression of WMH were assessed using the software programs MRICRON and ITK-SNAP on brain magnetic resonance imaging (MRI) and the hematoma volumes and absorption with ITK-SNAP software on CT. We assessed the association of WMH severity with ICH volume in 227 patients at baseline. Totally 183 of 227 patients underwent repeated CT within 14 days of ICH onset. The relationship of WMH severity to ICH absorption was analyzed in 183 patients. Additionally, among all 227 patients, 37 subjected to another MRI before ICH onset were divided into two groups according to WMH progression: non-progression and progression groups. The link between WMH progression and hematoma volume was examined. The ICH volume was significantly larger in patients with the highest WMH scores than in those with the lowest WMH scores. Larger WMH volume was independently associated with larger ICH volume (odds ratio 1.00; 95% CI, 1.00 to 1.00; P = 0.049). There was a trend towards WMH progression being related to ICH volume (P =0.049). Contrastingly, the WMH volume was not linked with hematoma absorption (P = 0.79). In conclusion, we found that greater severity and progression of WMH were associated with larger ICH volume. Our findings suggest that WMH might provide important prognostic information about patients with ICH and may have implications for treatment stratification.
Highlights
Intracerebral hemorrhage (ICH) is usually caused by the rupture of small penetrating arteries secondary to hypertensive changes or other vascular abnormalities [12]
2111 patients were ruled out: complete clinical data were lacking for 472 patients, brain magnetic resonance imaging (MRI) data were not available for 482 patients, fluid attenuated inversion recovery (FLAIR) imaging data were unavailable for 27 patients,241 patients had underlying aneurysm, 230 had vascular malformation or tumor, 136 had head trauma, 8 had intracranial venous sinus thrombosis, 12 had venous infarction, 22 had moyamoya disease, 18 had hemorrhagic transformation of ischemic infarction, and 451 had undergone surgical evacuation or craniectomy, 12 patients were excluded for other reasons
Baseline characteristics classified according to trichotomized Fazekas scale scores According to the Fazekas scale score, the 227 patients were divided into three groups: Group 1, Group 2, and Group 3
Summary
Intracerebral hemorrhage (ICH) is usually caused by the rupture of small penetrating arteries secondary to hypertensive changes or other vascular abnormalities [12]. WMH, or leukoaraiosis, represents areas of ischemic white matter damage attributed to degenerative changes to small vessels, including intimal hyperplasia, atherosclerosis, lipohyalinosis and amyloidosis [8]. Most researches focus on WMH is associated with ischemic stroke and less on ICH. One previous publication indicated greater WMH burden was associated with small vessel stroke compared with other ischemic stroke subtypes [10]. It was reported that the presence of WMH is an independent risk factor for warfarin-related ICH and ICH after thrombolytic treatment for acute ischemic stroke [11,12,13]. Severe WMH are associated with larger ICH volumes and hematoma growth [14]. We test our hypothesis that the severity and progression of WMH are related to hematoma volume and absorption in retrospective study
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