Temporal and Spatial Clustering of Intracerebral Hemorrhage in Cerebral Amyloid Angiopathy

Neurology. 2024 Sep 10;103(5):e209770. doi: 10.1212/WNL.0000000000209770. Epub 2024 Aug 16.

Abstract

Objectives: Cerebral amyloid angiopathy (CAA)-associated lobar intracerebral hemorrhage (ICH) has a high risk of recurrence, but the underlying mechanisms remain uncertain. We, therefore, aimed to characterize patterns of recurrent ICH.

Methods: We investigated early recurrent ICH (≥1 recurrent ICH event within 90 days of the index event) and ICH clusters (≥2 ICH events within 90 days at any time point) in 2 large cohorts of consecutive patients with first-ever ICH and available MRI.

Results: In 682 included patients (median age 68 years, 40.3% female, median follow-up time 4.1 years), 18 (2.6%) had an early recurrent ICH, which was associated with higher age and CAA. In patients with probable CAA, the risk of early recurrent ICH was increased 5-fold within the first 3 months compared with during months 4-12 (hazard ratio 5.41, 95% CI 2.18-13.4) while no significant difference was observed in patients without CAA. In patients with an ICH cluster, we observed spatial clustering (recurrent ICH within close proximity of index ICH in 63.0%) and a tendency for multiple sequential hemorrhages (≥3 ICH foci within 3 months in 44.4%).

Discussion: Our data provide evidence of both temporal and spatial clustering of ICH in CAA, suggesting a transient and localized active bleeding-prone process.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cerebral Amyloid Angiopathy* / complications
  • Cerebral Amyloid Angiopathy* / diagnostic imaging
  • Cerebral Amyloid Angiopathy* / epidemiology
  • Cerebral Hemorrhage* / diagnostic imaging
  • Cerebral Hemorrhage* / epidemiology
  • Cluster Analysis
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Recurrence*
  • Time Factors