Hsin-Hsi Tsai1,2, Bo-Ching Lee3, Ya-Fang Chen3, Jiann-Shing Jeng2, Li-Kai Tsai2. 1. Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan. 2. Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. 3. Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
Abstract
BACKGROUND AND PURPOSE: Cerebral venous flow alterations potentially contribute to age-related white matter changes, but their role in small vessel disease has not been investigated. METHODS: This study included 297 patients with hypertensive intracerebral hemorrhages (ICH) who underwent magnetic resonance imaging. Cerebral venous reflux (CVR) was defined as the presence of abnormal signal intensity in the dural venous sinuses or internal jugular vein on time-of-flight angiography. We investigated the association between CVR, dilated perivascular spaces (PVS), and recurrent stroke risk. RESULTS: CVR was observed in 38 (12.8%) patients. Compared to patients without CVR those with CVR were more likely to have high grade (>20 in the number) dilated PVS in the basal ganglia (60.5% vs. 35.1%; adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.25 to 5.60; P=0.011) and large PVS (>3 mm in diameter) (50.0% vs. 18.5%; aOR, 3.87; 95% CI, 1.85 to 8.09; P<0.001). During a median follow-up of 18 months, patients with CVR had a higher recurrent stroke rate (13.6%/year vs. 6.2%/year; aOR, 2.53; 95% CI, 1.09 to 5.84; P=0.03) than those without CVR. CONCLUSIONS: CVR may contribute to the formation of enlarged PVS and increase the risk of recurrent stroke in patients with hypertensive ICH.
BACKGROUND AND PURPOSE: Cerebral venous flow alterations potentially contribute to age-related white matter changes, but their role in small vessel disease has not been investigated. METHODS: This study included 297 patients with hypertensive intracerebral hemorrhages (ICH) who underwent magnetic resonance imaging. Cerebral venous reflux (CVR) was defined as the presence of abnormal signal intensity in the dural venous sinuses or internal jugular vein on time-of-flight angiography. We investigated the association between CVR, dilated perivascular spaces (PVS), and recurrent stroke risk. RESULTS: CVR was observed in 38 (12.8%) patients. Compared to patients without CVR those with CVR were more likely to have high grade (>20 in the number) dilated PVS in the basal ganglia (60.5% vs. 35.1%; adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.25 to 5.60; P=0.011) and large PVS (>3 mm in diameter) (50.0% vs. 18.5%; aOR, 3.87; 95% CI, 1.85 to 8.09; P<0.001). During a median follow-up of 18 months, patients with CVR had a higher recurrent stroke rate (13.6%/year vs. 6.2%/year; aOR, 2.53; 95% CI, 1.09 to 5.84; P=0.03) than those without CVR. CONCLUSIONS: CVR may contribute to the formation of enlarged PVS and increase the risk of recurrent stroke in patients with hypertensive ICH.
Entities:
Keywords:
Cerebral hemorrhage; Cerebral small vessel diseases; Cerebrovenous reflux; Hypertension; Perivascular space
Authors: Andreas Charidimou; Gregoire Boulouis; Marco Pasi; Eitan Auriel; Ellis S van Etten; Kellen Haley; Alison Ayres; Kristin M Schwab; Sergi Martinez-Ramirez; Joshua N Goldstein; Jonathan Rosand; Anand Viswanathan; Steven M Greenberg; M Edip Gurol Journal: Neurology Date: 2017-02-22 Impact factor: 9.910