Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage
Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage
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DOI：
10.1161/01.str.0000126807.69758.0e
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发表时间：
2004-06-01
期刊：
影响因子：
8.3
通讯作者：
Rosand, J
中科院分区：
文献类型：
--
作者：
Greenberg, SM;Eng, JA;Rosand, J
背景和目的：梯度回声MRI检测到的无症状小脑出血在脑出血（ICH）患者中很常见，特别是与脑淀粉样血管病（CAA）相关的脑叶性脑出血。我们试图确定在脑叶性脑出血时检测到的出血是否能预测CAA的主要临床并发症：脑出血复发或认知和功能下降。方法：在一项前瞻性队列研究中，对94名原发性脑叶性脑出血（年龄大于或等于55岁）的连续幸存者进行了32.9+/-24.0个月的随访。34名受试者在无卒中间隔15.8+/-6.5个月后接受第二次MRI检查。研究终点为复发性症状性脑出血或临床衰退，定义为认知障碍的发作、独立功能丧失或死亡。结果-基线出血总数预测未来症状性脑出血的风险（1、2、3 ~ 5或大于等于6次基线出血的受试者3年累积风险分别为14%、17%、38%和51%，P=0.003）。在以前没有痴呆或依赖的受试者中，基线时较高的出血数量也预示着随后认知障碍、独立性丧失或死亡的风险增加（P=0.002）。对于第二次MRI随访的受试者，34例中有17例出现新的微出血，并预测随后出现症状性脑出血的风险增加（新微出血0例、1例至3例或大于或等于4例的受试者，3年累积风险分别为19%、42%和67%，P=0.02），但随后的临床衰退并未出现。结论：MRI发现的出血可预测脑叶性脑出血幸存者的重要临床事件。微量出血的检测可能有助于评估脑出血患者的风险，并作为临床研究的替代指标。
Background and Purpose-Small asymptomatic cerebral hemorrhages detectable by gradient-echo MRI are common in patients with intracerebral hemorrhage (ICH), particularly lobar ICH related to cerebral amyloid angiopathy (CAA). We sought to determine whether hemorrhages detected at the time of lobar ICH predict the major clinical complications of CAA: recurrent ICH or decline in cognition and function.Methods-Ninety-four consecutive survivors of primary lobar ICH (agegreater than or equal to55) with gradient-echo MRI at presentation were followed in a prospective cohort study for 32.9+/-24.0 months. A subset of 34 subjects underwent a second MRI after a stroke-free interval of 15.8+/-6.5 months. Study endpoints were recurrent symptomatic ICH or clinical decline, defined as onset of cognitive impairment, loss of independent functioning, or death.Results-The total number of hemorrhages at baseline predicted risk of future symptomatic ICH (3-year cumulative risks 14%, 17%, 38%, and 51% for subjects with 1, 2, 3 to 5, or greater than or equal to6 baseline hemorrhages, P=0.003). Higher numbers of hemorrhages at baseline also predicted increased risk for subsequent cognitive impairment, loss of independence, or death (P=0.002) among subjects not previously demented or dependent. For subjects followed after a second MRI, new microhemorrhages appeared in 17 of 34 and predicted increased risk of subsequent symptomatic ICH (3-year cumulative risks 19%, 42%, and 67% for subjects with 0, 1 to 3, or greater than or equal to4 new microhemorrhages, P=0.02), but not subsequent clinical decline.Conclusions-Hemorrhages identified by MRI predict clinically important events in survivors of lobar ICH. Detection of microhemorrhages may be useful for assessing risk in ICH patients and as a surrogate marker for clinical studies.