Temporal and Spatial Clustering of Intracerebral Hemorrhage in Cerebral Amyloid Angiopathy
Simon Fandler‐Höfler, Gareth Ambler, Gargi Banerjee, Philip S. Nash, Lena Obergottsberger, Gerit Wünsch, Christian Kiss, Linda Fabisch, Markus Kneihsl, Wenpeng Zhang, Hatice Özkan, Martina Locatelli, Yang Du, Larysa Panteleienko, Rom Mendel, Kitti Thiankhaw, Robert Simister, Hans Rolf Jäger, Christian Enzinger, Thomas Gattringer, David J. Werring
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.