White matter hyperintensity patterns in cerebral amyloid angiopathy and hypertensive arteriopathy

Andreas Charidimou, Gregoire Boulouis, Kellen Haley, Eitan Auriel, Ellis S. Van Etten, Panagiotis Fotiadis, Yael Reijmer, Alison Ayres, Anastasia Vashkevich, Zora Y. Dipucchio, Kristin M. Schwab, Sergi Martinez-Ramirez, Jonathan Rosand, Anand Viswanathan, Steven M. Greenberg, M. Edip Gurol

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To identify different white matter hyperintensity (WMH) patterns between 2 hemorrhage-prone cerebral small vessel diseases (SVD): cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy (HA). Methods: Consecutive patients with SVD-related intracerebral hemorrhage (ICH) from a single-center prospective cohort were analyzed. Four predefined subcortical WMH patterns were compared between the CAA and HA groups. These WMH patterns were (1) multiple subcortical spots; (2) peri-basal ganglia (BG); (3) large posterior subcortical patches; and (4) anterior subcortical patches. Their associations with other imaging (cerebral microbleeds [CMBs], enlarged perivascular spaces [EPVS]) and clinical markers of SVD were investigated using multivariable logistic regression. Results: The cohort included 319 patients with CAA and 137 patients with HA. Multiple subcortical spots prevalence was higher in the CAA compared to the HA group (29.8% vs 16.8%; p 0.004). Peri-BG WMH pattern was more common in the HA-vs the CAA-ICH group (19% vs 7.8%; p 0.001). In multivariable logistic regression, presence of multiple subcortical spots was associated with lobar CMBs (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.01-1.50, p 0.039) and high degree of centrum semiovale EPVS (OR 2.43; 95% CI 1.56-3.80, p < 0.0001). By contrast, age (OR 1.05; 95% CI 1.02-1.09, p 0.002), deep CMBs (OR 2.46; 95% CI 1.44-4.20, p 0.001), total WMH volume (OR 1.02; 95% CI 1.01-1.04, p 0.002), and high BG EPVS degree (OR 8.81; 95% CI 3.37-23.02, p < 0.0001) were predictors of peri-BG WMH pattern. Conclusion: Different patterns of subcortical leukoaraiosis visually identified on MRI might provide insights into the dominant underlying microangiopathy type as well as mechanisms of tissue injury in patients with ICH.

Original languageEnglish
Pages (from-to)505-511
Number of pages7
JournalNeurology
Volume86
Issue number6
DOIs
StatePublished - 9 Feb 2016
Externally publishedYes

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