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Abstract
Objective Black and Hispanic survivors of intracerebral hemorrhage (ICH) are at higher risk of recurrent intracranial bleeding. MRI-based markers of chronic cerebral small vessel disease (CSVD) are consistently associated with recurrent ICH. We therefore sought to investigate whether racial/ethnic differences in MRI-defined CSVD subtype and severity contribute to disparities in ICH recurrence risk.
Methods We analyzed data from the Massachusetts General Hospital ICH study (n = 593) and the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study (n = 329). Using CSVD markers derived from MRIs obtained within 90 days of index ICH, we classified ICH cases as cerebral amyloid angiopathy (CAA)–related, hypertensive arteriopathy (HTNA)–related, and mixed etiology. We quantified CSVD burden using validated global, CAA-specific, and HTNA-specific scores. We compared CSVD subtype and severity among White, Black, and Hispanic ICH survivors and investigated its association with ICH recurrence risk.
Results We analyzed data for 922 ICH survivors (655 White, 130 Black, 137 Hispanic). Minority ICH survivors had greater global CSVD (p = 0.011) and HTNA burden (p = 0.021) on MRI. Furthermore, minority survivors of HTNA-related and mixed-etiology ICH demonstrated higher HTNA burden, resulting in increased ICH recurrence risk (all p < 0.05).
Conclusions We uncovered significant differences in CSVD subtypes and severity among White and minority survivors of primary ICH, with direct implication for known disparities in ICH recurrence risk. Future studies of racial/ethnic disparities in ICH outcomes will benefit from including detailed MRI-based assessment of CSVD subtypes and severity and investigating social determinants of health.
Glossary
- BG=
- basal ganglia;
- CAA=
- cerebral amyloid angiopathy;
- CI=
- confidence interval;
- CMB=
- cerebral microbleed;
- CSO=
- centrum semiovale;
- cSS=
- cortical superficial siderosis;
- CSVD=
- cerebral small vessel disease;
- FDR=
- false discovery rate;
- EPVS=
- enlarged perivascular spaces;
- ERICH=
- Ethnic/Racial Variations of Intracerebral Hemorrhage;
- FLAIR=
- fluid-attenuated inversion recovery;
- HTNA=
- hypertensive arteriopathy;
- ICH=
- intracerebral hemorrhage;
- IQR=
- interquartile range;
- MGH=
- Massachusetts General Hospital;
- SWI=
- susceptibility-weighted image;
- T2*-GRE=
- T2*-weighted gradient recalled echo;
- WMH=
- white matter hyperintensities
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
- Received September 29, 2020.
- Accepted in final form February 24, 2021.
- © 2021 American Academy of Neurology
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