Asymptomatic Striatocapsular slit-like Hemorrhage as a Severity Marker in Patients with Hypertensive Angiopathy |
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| Affiliation: | 2. Departments of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan;3. Departments of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan;4. Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan;6. Departments of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan;2. Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States;3. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States;4. Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States;5. VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, United States;2. Department of Neurology, Creighton University School of Medicine, Omaha, NE;3. Department of Neurology, University of Texas Rio Grande Valley, Department of Neuroscience, Valley Baptist Hospital, Harlingen, TX;4. St. Cloud Hospital, St. Cloud, MN;2. Neurology department/Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy;3. Department of Medical Imaging, University Health Network, Toronto, ON, Canada;4. Neurofarba Department, University of Florence, Florence, Italy;5. Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada;8. Stroke Unit, University Hospital of Parma, Parma, Italy;9. Stroke Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy;2. Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan;2. Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School |
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| Abstract: | BackgroundConcomitant asymptomatic striatocapsular slit-like hemorrhage (SSH) is occasionally found in patients of spontaneous intracerebral hemorrhage (ICH), but was seldomly described in the literature. In this study, we described the clinico-radiological features of asymptomatic SSH in ICH patients with hypertensive microangiopathy.Methods and Results246 patients with strictly deep or mixed deep and lobar ICH/microbleeds were included. SSH was defined as hypointense lesions involving the lateral aspect of lentiform nucleus or external capsule in slit shape (>1.5 cm) on susceptibility-weighted imaging without history of associated symptoms. Demographics and neuroimaging markers were compared between patients with SSH and those without. Patients with SSH (n=24, 10%) and without SSH had comparable age (62.0 ± 12.6 vs. 62.3 ± 13.5, p = 0.912) and vascular risk factor profiles including the diagnosis of chronic hypertension, diabetes, and dyslipidemia (all p>0.05). SSH was associated with more common lobar microbleeds (79.2% vs 48.2%, p = 0.005), lacunes (75% vs. 41.4%, p = 0.002) and higher white matter hyperintensity (WMH) volumes (24.1 [10.4–46.3] vs. 13.9 [7.0–24.8] mL, p = 0.012) on MRI, as well as more frequent left ventricular hypertrophy (LVH) (50.0% vs. 20.5%, p = 0.004) and albuminuria (41.7% vs. 19.4%, p = 0.018). In multivariable analyses, SSH remains independently associated with LVH (p = 0.017) and albuminuria (p = 0.032) after adjustment for age, sex, microbleed, lacune and WMH volume.ConclusionsAsymptomatic SSH is associated with more severe cerebral small vessel disease-related change on brain MRI, and hypertensive cardiac and renal injury, suggesting a more advanced stage of chronic hypertension. |
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