International Epidemiology of Intracerebral Hemorrhage

Ikram, M. Arfan; Wieberdink, Renske G.; Koudstaal, Peter J.

doi:10.1007/s11883-012-0252-1

Cited by 228 publications

(171 citation statements)

References 50 publications

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“…Visual assessment of florbetapir-PET The main focus of our analysis was assessing florbetapir as a clinically available diagnostic marker for distinguishing CAA from non-CAA causes of ICH, particularly hypertensive small vessel disease. HTN and CAA are the most common etiologies of deep hemispheric and lobar ICH, respectively, in older adults, 24 as well as causing ischemic injuries such as leukoaraiosis or lacunar infarcts. 23 Distinguishing CAA from non-CAA can play a major role in clinical decision-making, as CAA confers a particularly high risk of future ICH and dementia.…”

Section: Resultsmentioning

confidence: 99%

Florbetapir-PET to diagnose cerebral amyloid angiopathy

et al. 2016

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Objective: We hypothesized that florbetapir, a Food and Drug Administration-approved PET tracer, could distinguish cerebral amyloid angiopathy (CAA)-related intracerebral hemorrhage (ICH) from hypertensive ICH (HTN-ICH). Methods:We prospectively enrolled survivors of primary ICH related to probable CAA (per Boston Criteria, n 5 10) and HTN-ICH (n 5 9) without dementia. All patients underwent florbetapir-PET and multimodal MRI, and patients with CAA had additional Pittsburgh compound B (PiB) PET. Amyloid burden was assessed quantitatively (standard uptake value ratio [SUVR]) and visually classified as positive or negative. Results:The CAA and HTN-ICH groups had similar age (66.9 vs 67.1), sex, and leukoaraiosis volumes (31 vs 30 mL, all p . 0.8). Florbetapir uptake and PiB retention strongly correlated in patients with CAA both globally within cerebral cortex (r 5 0.96, p , 0.001) and regionally in lobar cortices (all r . 0.8, all p # 0.01). Mean global cortical florbetapir uptake was substantially higher in CAA than HTN-ICH (SUVR: 1.41 6 0.17 vs 1.15 6 0.08, p 5 0.001), as was mean occipital SUVR (1.44 6 0.12 vs 1.17 6 0.08, p , 0.001), even after correcting for global SUVR (p 5 0.03). Visual rating for positive/negative florbetapir demonstrated perfect interrater agreement (k 5 1) and was positive for all 10 patients with CAA vs 1 of 9 HTN-ICH patients (sensitivity 100%, specificity 89%).Conclusions: Florbetapir appears to label vascular amyloid in patients with CAA-related ICH. The approved florbetapir binary visual reading method can have diagnostic value in appropriate clinical settings. Classification of evidence:This study provides Class II evidence that florbetapir-PET provides a sensitivity of 100% (95% confidence interval [CI] 66%-100%) and specificity of 89% (95% CI 51%-99%) for determination of probable CAA among cognitively normal patients. Cerebral amyloid angiopathy (CAA), characterized by accumulation of b-amyloid (Ab) proteins in the walls of cortical/leptomeningeal vessels, is a common cause of vessel wall breakdown and vascular dysfunction in older adults, making it a major contributor to fatal or disabling intracerebral hemorrhages (ICH) as well as ischemic injury and dementia. 1,2 There currently is no specific treatment for CAA, in part because of our inability to identify this condition at early phases prior to appearance of multiple hemorrhagic brain lesions. 3 Accurate early diagnosis of CAA also has direct implications for stroke prevention, as this pathology is an important cause of anticoagulant-associated ICH and might dictate use of alternative nonpharmaceutical approaches such as left atrial appendage closure for patients with nonvalvular atrial fibrillation. 4,5

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Section: Resultsmentioning

confidence: 99%

Florbetapir-PET to diagnose cerebral amyloid angiopathy

et al. 2016

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“…Of all cerebral strokes, hemorrhagic stroke forms approximately 15%, of which hypertensive intracranial hematomas (HIH) constitute the vast majority [1,2]. Intracranial hemorrhage (ICH), contrary to popular belief, is not a 'modern disease' and is mentioned as 'Cerebral Apoplexy' in the writings of antiquity credited to Hippocrates [3].…”

Section: Introductionmentioning

confidence: 99%

Introductory Chapter: An Introduction to Hypertension-Related Intracerebral Hematomas

Dadlani¹,

Agrawal²

2017

Hemorrhagic Stroke - An Update

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“…1 Dyslipidemia is an important risk factor for ischemic stroke and statins use significantly decrease risk of recurrence of ischemic stroke. However the association between lipid levels, statins use and risk of ICH is controversial and not clear.…”

Section: Introductionmentioning

confidence: 99%

Blood lipid levels, statin therapy and risk of intracerebral hemorrhage versus ischemic vascular events: a prospective case control study from tertiary care center of south India

et al. 2016

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INTRODUCTIONICH is the second most common subtype of stroke after ischemic stroke and accounts for approximately 10% to 20% of all strokes and is characterized by high mortality and morbidity.1 Dyslipidemia is an important risk factor for ischemic stroke and statins use significantly decrease risk of recurrence of ischemic stroke. However the association between lipid levels, statins use and risk of ICH is controversial and not clear.Most research studies have shown that lower total cholesterol, lower LDL cholesterol, and higher HDL were associated with increased risk of ICH.2 However the association between TG and VLDL and risk of ICH is not clear.In the present study we prospectively recruited patients with symptomatic ICH in a case control design to know the relationship between individual lipid fractions and risk of ICH. ABSTRACTBackground: Intracerebral hemorrhage (ICH) is characterized by high mortality and morbidity. A little is known about the association between blood lipids, statin use and risk of ICH. Objective of the study was to investigate the relation between blood lipid levels and risk of hemorrhagic stroke. Methods: Prospectively compared the lipid levels of primary ICH patients (case) with ischemic group (control) patients, i.e. age and sex matched individuals admitted from January 2014 to January 2015 and outcome analyzed. Results: Of the 678 acute stroke patients, 78 (11.5%) had ICH who was enrolled. Mean age was 53±14.4. ICH was frequent in older age (57.6%) with male gender predominance (73%). Most frequent location of bleed was in thalamus (30.7%). Low density lipoprotein (LDL), triglyceride (TG) and very low density lipoprotein (VLDL) cholesterol were significantly low in ICH patients compared to controls. There was no significant difference in the high density lipoprotein (HDL) levels in both groups. Mean total cholesterol was significantly low in a subset of study group that included male gender, younger onset stroke (<50 years) and with prior history of hypertension. Subgroup analysis in ICH group showed significantly low mean total cholesterol, LDL and TG cholesterol in statin group compared to non-statin group. Conclusions: Lower blood lipid levels are associated with an increased risk of ICH. The reduction of blood lipids due to statin therapy might increase the risk of ICH, especially in hypertensive individuals and those with alcohol use; hence there should be a cautious use of statins.

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International Epidemiology of Intracerebral Hemorrhage

Cited by 228 publications

References 50 publications

Florbetapir-PET to diagnose cerebral amyloid angiopathy

Florbetapir-PET to diagnose cerebral amyloid angiopathy

Introductory Chapter: An Introduction to Hypertension-Related Intracerebral Hematomas

Blood lipid levels, statin therapy and risk of intracerebral hemorrhage versus ischemic vascular events: a prospective case control study from tertiary care center of south India

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