Etiology of Primary Cerebellar Intracerebral Hemorrhage Based on Topographic Localization.
Etiology of Primary Cerebellar Intracerebral Hemorrhage Based on Topographic Localization.
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基于地形定位的原发性小脑脑出血的病因学。
DOI：
10.1161/strokeaha.123.044271
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发表时间：
2023
期刊：
影响因子：
8.3
通讯作者：
Lioutas,Vasileios-Arsenios
中科院分区：
文献类型：
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作者：
Incontri,Diego;Marchina,Sarah;Andreev,Alexander;Wilson,Mitchell;Wang,Jia-Yi;Lin,David;Heistand,ElizabethC;Carvalho,Filipa;Selim,Magdy;Lioutas,Vasileios-Arsenios
背景小脑性脑内出血（cICH）通常归因于高血压或脑淀粉样血管病（CAA）。然而，破译确切的病因可能具有挑战性。最近的一项研究报告了继发于CAA的浅表cICH的地形学病因学关系。我们的目的是在一个单独的患者队列中，使用最新的波士顿标准2.0版，重新检查这种地形和病因之间的关系。方法我们对2000年至2022年在三级学术中心收治的原发性cICH连续患者进行了回顾性分析。将脑计算机断层扫描/磁共振成像扫描上的cICH位置严格分为浅表（皮质、周围白色物质、蚓部）与深部（小脑核、深部白色物质、大脑脚区域）或混合（两个区域）。磁共振成像被评定为脑小血管疾病的标志物。我们采用波士顿标准2.0将可能/很可能与不存在CAA进行了分组。我们纳入了197例患者，其中106例（53.8%）为女性，中位年龄为74（63-82）岁。五十六例（28%）患者发生浅表性cICH，141例（72%）发生深部/混合性cICH。112例（57%）患者（30例[26.8%]浅表性和82例[73.2%]深部/混合性cICH）的磁共振成像可用。浅表cICH患者更可能发生可能/很可能CAA（48.3% vs 8.6%;比值比[OR]，11.43 [95% CI，3.26-40.05];P<0.001），严格的脑叶微出血（51.7%对6.2%; OR，14.18 [95% CI，3.98-50.50];P<0.001）和皮质浅表铁质沉着症（13.8%对1.2%; OR，7.70 [95% CI，0.73-80.49];P=0.08）。深度/混合性cICH患者更可能发生深度/混合性脑微出血（59.2% vs 3.4%; OR，41.39 [95% CI，5.01-341.68];P=0.001），腔隙（54.9% vs 17.2%; OR，6.14 [95% CI，1.89-19.91];P=0.002），重度基底节区血管周围间隙扩大（36.6% vs 7.1%; OR，7.63 [95% CI，1.58-36.73];P=0.01），高血压（84.4% vs 62.5%; OR，3.43 [95% CI，1.61至-7.30]; P=0.001），且入院时收缩压较高（172 [146-200] vs 146 [124-158] mm Hg，P<0.001）。结论：我们的结果表明，浅表cICH与CAA密切相关，而深部cICH与CAA密切相关。混合性cICH与高血压动脉病密切相关。
BACKGROUNDCerebellar intracerebral hemorrhage (cICH) is often attributed to hypertension or cerebral amyloid angiopathy (CAA). However, deciphering the exact etiology can be challenging. A recent study reported a topographical etiologic relationship with superficial cICH secondary to CAA. We aimed to reexamine this relationship between topography and etiology in a separate cohort of patients and using the most recent Boston criteria version 2.0.METHODSWe performed a retrospective analysis of consecutive patients with primary cICH admitted to a tertiary academic center between 2000 and 2022. cICH location on brain computed tomography/magnetic resonance imaging scan(s) was divided into strictly superficial (cortex, surrounding white matter, vermis) versus deep (cerebellar nuclei, deep white matter, peduncular region) or mixed (both regions). Magnetic resonance imaging was rated for markers of cerebral small vessel disease. We assigned possible/probable versus absent CAA using Boston criteria 2.0.RESULTSWe included 197 patients; 106 (53.8%) were females, median age was 74 (63–82) years. Fifty-six (28%) patients had superficial cICH and 141 (72%) deep/mixed cICH. Magnetic resonance imaging was available for 112 (57%) patients (30 [26.8%] with superficial and 82 [73.2%] with deep/mixed cICH). Patients with superficial cICH were more likely to have possible/probable CAA (48.3% versus 8.6%; odds ratio [OR], 11.43 [95% CI, 3.26–40.05];P<0.001), strictly lobar cerebral microbleeds (51.7% versus 6.2%; OR, 14.18 [95% CI, 3.98–50.50];P<0.001), and cortical superficial siderosis (13.8% versus 1.2%; OR, 7.70 [95% CI, 0.73–80.49];P=0.08). Patients with deep/mixed cICH were more likely to have deep/mixed cerebral microbleeds (59.2% versus 3.4%; OR, 41.39 [95% CI, 5.01–341.68];P=0.001), lacunes (54.9% versus 17.2%; OR, 6.14 [95% CI, 1.89–19.91];P=0.002), severe basal ganglia enlarged perivascular spaces (36.6% versus 7.1%; OR, 7.63 [95% CI, 1.58–36.73];P=0.01), hypertension (84.4% versus 62.5%; OR, 3.43 [95% CI, 1.61 to −7.30];P=0.001), and higher admission systolic blood pressure (172 [146–200] versus 146 [124–158] mm Hg,P<0.001).CONCLUSIONSOur results suggest that superficial cICH is strongly associated with CAA whereas deep/mixed cICH is strongly associated with hypertensive arteriopathy.