Cerebral Microbleeds, Hypertension, and Intracerebral Hemorrhage in Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

Jung Seok Lee; KeunHyuk Ko; Jung-Hwan Oh; Joon Hyuk Park; Ho Kyu Lee; David Floriolli; Annlia Paganini-Hill; Mark Fisher

doi:10.3389/fneur.2017.00203

Cerebral Microbleeds, Hypertension, and Intracerebral Hemorrhage in Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

Front Neurol. 2017 May 15:8:203. doi: 10.3389/fneur.2017.00203. eCollection 2017.

Authors

Jung Seok Lee^{1

2}, KeunHyuk Ko¹, Jung-Hwan Oh¹, Joon Hyuk Park³, Ho Kyu Lee⁴, David Floriolli⁵, Annlia Paganini-Hill², Mark Fisher^{2

6

7}

Affiliations

¹ Department of Neurology, Jeju National University School of Medicine, Jeju City, South Korea.
² Department of Neurology, University of California Irvine School of Medicine, Irvine, CA, United States.
³ Department of Psychiatry, Jeju National University School of Medicine, Jeju City, South Korea.
⁴ Department of Radiology, Jeju National University School of Medicine, Jeju City, South Korea.
⁵ Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, United States.
⁶ Department of Anatomy & Neurobiology, University of California Irvine School of Medicine, Irvine, CA, United States.
⁷ Department of Pathology & Laboratory Medicine, University of California Irvine School of Medicine, Irvine, CA, United States.

Abstract

Background: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common genetic cause of stroke. In addition to ischemic stroke, CADASIL predisposes to development of cerebral microbleeds (CMB). CMB and hypertension are known to be associated with intracerebral hemorrhage (ICH). The purpose of this study was to analyze the relationships among CMB, hypertension, and ICH in CADASIL.

Materials and methods: We enrolled 94 genetically confirmed CADASIL patients from 76 unrelated families at Jeju National University Hospital (Korea) between March 2012 and February 2015. We analyzed CMB presence, number, and distribution on susceptibility-weighted imaging MRI using the microbleed anatomical rating scale. Multiple logistic regression was used to determine factors associated with the presence of CMB and ICH.

Results: CMB were observed in 62 patients (66%), median number of CMB per patient was 4 (range 0-121). Twenty-two ICHs were found in 16 patients (17%). There was incongruence between the most common site of CMB (thalamus) and that of ICH (basal ganglia). Hypertension was independently associated with the presence of CMB (multiple regression OR, 2.71; 95% CI 1.02-7.18, p < 0.05), and CMB ≥ 9 (highest third) was significantly associated with the presence of ICH (multiple regression OR = 9.50, 95% CI 1.08-83.71, p < 0.05).

Conclusion: In this CADASIL sample, presence of hypertension was independently associated with CMB presence, and CMB burden was independently associated with ICH. Incongruence of sites for CMB and ICH is currently unexplained and requires further study.

Keywords: CADASIL; hypertension; intracerebral hemorrhage; microbleeds; stroke.