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Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage.

ABSTRACT: The CT angiography (CTA) spot sign predicts hematoma expansion and poor outcome in patients with primary intracerebral hemorrhage (ICH). The biological underpinnings of the spot sign remain poorly understood; it may be that the underlying vasculopathy influences its presence. Therefore, we conducted a study to identify genetic predictors of the spot sign.In an ongoing prospective cohort study, we analyzed 371 patients with CTA and genetic data available. CTAs were reviewed for the spot sign by 2 experienced readers, blinded to clinical data, according to validated criteria. Analyses were stratified by ICH location.In multivariate analysis, patients on warfarin were more likely to have a spot sign regardless of ICH location (OR, 3.85; 95% CI, 1.33-11.13 in deep ICH and OR, 2.86; 95% CI, 1.33-6.13 in lobar ICH). Apolipoprotein E ?2, but not ?4, was associated with the presence of a spot sign in lobar ICH (OR, 2.09; 95% CI, 1.05-4.19). There was no effect for ?2 or ?4 in deep ICH.Patients with ICH on warfarin are more likely to present with a spot sign regardless of ICH location. Among patients with lobar ICH, those who possess the apolipoprotein E ?2 allele are more likely to have a spot sign. Given the established relationship between apolipoprotein E ?2 and vasculopathic changes in cerebral amyloid angiopathy, our findings suggest that both hemostatic factors and vessel pathology influence spot sign presence.

SUBMITTER: Brouwers HB

PROVIDER: S-EPMC3426364 | biostudies-literature | 2012 Aug

REPOSITORIES: biostudies-literature

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Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage.

Brouwers H Bart HB Biffi Alessandro A McNamara Kristen A KA Ayres Alison M AM Valant Valerie V Schwab Kristin K Romero Javier M JM Viswanathan Anand A Greenberg Steven M SM Rosand Jonathan J Goldstein Joshua N JN

Stroke 20120523 8

<h4>Background and purpose</h4>The CT angiography (CTA) spot sign predicts hematoma expansion and poor outcome in patients with primary intracerebral hemorrhage (ICH). The biological underpinnings of the spot sign remain poorly understood; it may be that the underlying vasculopathy influences its presence. Therefore, we conducted a study to identify genetic predictors of the spot sign.<h4>Methods</h4>In an ongoing prospective cohort study, we analyzed 371 patients with CTA and genetic data avail ...[more]

PMID: 22621984

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Project description:BackgroundIdentifying the cause of intracerebral hemorrhage (ICH) is relevant to optimize its management. We aimed to assess the applicability and utility of the Edinburgh CT criteria for cerebral amyloid angiopathy (CAA) in an unselected cohort of hospitalized patients.Patients and methodsWe retrospectively applied the Edinburgh criteria to the first available brain CTs of patients hospitalized for a first-ever lobar ICH in the district of L'Aquila from 2011 to 2017. ICH characteristics and outcomes were compared according to the presence of the Edinburgh CT criteria, including associated subarachnoid hemorrhage (aSAH) and finger-like projections (FLPs). The outcome of ICH in-hospital mortality was assessed with multivariate logistic regression analysis. We adopted the Edinburgh criteria, age, NIHSS and Glasgow Coma Scale scores, systolic blood pressure, antiplatelet treatment, ICH volume, and intraventricular extension on admission as covariates.ResultsOf 178 patients with lobar ICH, 52 (29.2%) had aSAH+FLPs, 60 (33.7%) aSAH only, 1 (0.6%) FLPs, and 65 (36.5%) none. Patients with aSAH+FLPs were older (79.0 ± 9.2 years) than those with only one criterion or none (74.0 ± 15.3 and 72.2 ± 13.8 years, respectively; P = 0.020). Patients with aSAH+FLPs also had more severe ICH at onset, higher in-hospital case-fatality (log rank test P = 0.003) and higher mRS scores at discharge (P < 0.001) as compared to those fulfilling one or none of the Edinburgh criteria. Low Glasgow Coma Scale score was the only factor independently associated to in-hospital case-fatality (odds ratio per point increase 0.51; 95% confidence interval, 0.32-0.91; P = 0.021).DiscussionOur data suggest the applicability of the Edinburgh CT criteria in a hospital setting. The presence of those criteria reflects ICH clinical severity.ConclusionsApplying the Edinburgh CT criteria might help refining the diagnosis and improving the management of patients with lobar ICH.

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Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage.

Publications

Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage.

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