Study reveals potential risk factors for lobar ICH in cerebral amyloid angiopathy

Antithrombotic use after a transient focal neurological episode, as well as motor forms of these episodes, increased risk for lobar intracerebral hemorrhage, according to results of a systematic review and meta-analysis.

“Specific [transient focal neurological episode (TFNE)]-associated risk factors for lobar hemorrhage or mortality have not been studied, to our knowledge,” Juan María Sanchez-Caro, MD, of the department of neurology at the Hospital La Paz Institute for Health Research–IdiPAZ in Spain, and colleagues wrote. “We believe there is a knowledge gap in the clinical and radiological characteristics of TFNEs and their potential implications in [cerebral amyloid angiopathy (CAA)] prognosis.”

To address this research gap, the investigators conducted a systematic review and individual participant meta-analysis incorporating data from a hospital-based cohort and a systematic search of two databases completed in December 2019. They included observational reports of TFNEs that had patient-level clinical, imaging and prognostic data. They requested patient-level data for aggregate data studies.

Exposures included the clinical characteristics of TFNEs, neuroimaging features and antithrombotic use during follow-up. Lobar intracerebral hemorrhage (ICH) and risk for death during follow-up served as the predefined main outcomes.

Sanchez-Caro and colleagues included 42 studies and 222 CAA-associated cases from the initial 1,612 records returned via the systematic search. The hospital-based cohort provided 26 additional patients. Results showed 108 TFNEs (43.5%) consisted of motor symptoms. The researchers reported convexity subarachnoid hemorrhage and cortical superficial siderosis among 193 patients (77.8%) in the systematic search and 156 patients (62.9%) in the hospital-based cohort.

They obtained follow-up duration (median duration, 1 year) from 185 patients. They noted symptomatic lobar ICH among 76 patients (39.4%) during follow-up. Motor symptoms (OR = 2.08; 95% CI, 1.16-3.7) at baseline and antithrombotic use during follow-up (OR = 3.61; 95% CI, 1.67-7.84) correlated with increased risk for lobar ICH. During follow-up, 31 patients (16.5%) died. The main risk factors for death were lobar ICH during follow-up (OR = 3.01; 95% CI, 1.36-6.69) and cortical superficial siderosis (OR = 3.2; 95% CI, 1.16-8.91).

“This study reveals motor TFNEs and antithrombotic treatment as potential risk factors for lobar ICH in CAA and supports the association between [cortical superficial siderosis] and an increase in mortality,” Sanchez-Caro and colleagues wrote. “Through a better understanding of TFNEs and CAA and a more accurate stratification of the hemorrhage risk, our work could help clinicians improve the management of patients with CAA.”