Abstract Details

Title Cerebral Small Vessel Disease Markers and Their Relation to Hematoma Volume, Expansion and Functional Outcome

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-006

Objective Primary: To assess the relationship of WMHL (white matter hyperintense lesions), microbleeds(MBs) and cortical siderosis (CSS) with hematoma expansion (HE) and volume in patients with hypertensive ICH. Secondary: To assess the relationship of Cerebral Small Vessel Disease markers to the functional outcome at three months in hypertensive intracerebral hemorrhage.

Background The role of cerebral small vessel disease (CSVD) in determining hematoma volume and growth is a subject of debate with mixed results from previous studies.

Design/Methods

Design: Prospective Cohort study with 3 month followup

Population: All consecutive acute hypertensive supratentorial ICH who presented to the ED of our institution between September 2016 to February 2018 were prospectively recruited.

Materials and Methods: Serial CT to assess baseline and final hematoma volume and MRI for CSVD markers were performed in all subjects. WMHL (graded using Fazeka’s) dichotomised as Fazeka score > or ≤3, MBs dichotomised as > or ≤ 2 and presence or absence of CSS assessed and compared with baseline variables and outcomes [in terms of modified Rankin scale - Good (mRS 0,1,2,3) and Poor (mRS 4,5,6) outcome]. All the images were assessed by an experienced Stroke Neurologist and a Neuroradiologist.

Results

157 patients were screened and 60included for final analysis. 19/60(28.1%) had HE and 31/60(51.6%) had major bleed (>30ml) and 28/59(47.46%) had poor 3month outcome(mRs5,6). On univariate analysis WMHL was associated with greater HE(p=0.001), larger volume ICH [Mean(SD),39.08±24.50ml vs 27.66±18.48,p=0.048] and poor outcome(mRs5,6 p=0.001). MBs were associated with poor outcome[p=0.029] but not with HE/volume. CSS was related to HE(p=0.031), a large volume bleed(p=0.023) and poor outcome(p=0.021). On Multivariate model only WMHL independantly predicted HE(OR:2.65,CI (1.15-40.17, p=0.034), large volume bleed (>30ml)[OR:7.16,CI(1.09-47.13)p=0.041 and poor outcome[OR:2.1(CI-0.05-3.27),p=0.042]

Conclusions White matter lesion load in MRI serves as a predictor of hematoma expansion, a large volume bleed and poor outcome in hypertensive ICH and may be incorporated into existing prediction models.

Authors/Disclosures
PRESENTER	No disclosure on file
Rohit Bhatia, MD, MBBS, DM	Dr. Bhatia has nothing to disclose.
Ajay Garg	Ajay Garg has nothing to disclose.
	No disclosure on file
Manjari Tripathi, MD (ALL INDIA INSTITUTE OF MEDICAL SCIENCES)	Dr. Tripathi has nothing to disclose.
Deepa Dash, MD, DM	Dr. Dash has nothing to disclose.
Padma V. Hadakasira, MD (Medwis Healthcare Communications Pvt Ltd)	Dr. Hadakasira has nothing to disclose.
Kameshwar Prasad, MD (Rajendra Institute of Medical Sciences, Ranchi)	The institution of Prof. Prasad has received research support from Government of India Departments of Health Research and Biotechnology.
	No disclosure on file

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