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Spontaneous intracerebral hemorrhage (ICH) is a devastating stroke that refers to intra-sulci hemorrhage
caused by a damaged arteriole or arterial vessel rupture.
Cerebral small vessel disease (SVD), especially hypertensive SVD, is the most common underlying lesion
of ICH.
Typical imaging findings on conventional magnetic resonance imaging (MRI) reflecting parenchymal injury to SVD include cerebral microhemorrhage, white matter hyperplasia (WMHs), fissures, and enlargement
of the perivascular spaces (PVSs) of the basal ganglia (BG).
Although While chronic hypertension, aging, and other vascular risk factors contribute to the development of cerebral arteriosclerotic changes in hypertensive ICH, the underlying pathogenesis may be multifaceted and in many ways remains unknown
.
The study included 297 hypertensive
patients with intracerebral hemorrhage (ICH) who underwent magnetic resonance imaging.
Cerebral venous return (CVR) is defined as the presence of abnormal signal intensity
in the dural venous sinuses or internal jugular veins on time-of-flight angiography.
Scholars from Taiwan investigated the relationship between
CVR, dilated perivascular space (PVS) and the risk of recurrent stroke.
The results showed that 38 (12.
8%) patients developed CVR
.
Patients with CVR were more likely to have more (number>20) dilated PVS in the basal ganglia than those without CVR (60.
5% vs.
35.
1%; OR=2.
64; 95% confidence interval [CI], 1.
25 to 5.
60; P=0.
011) and large PVS (diameter>3 mm) (50.
0% vs.
18.
5%; aOR, 3.
87; 95% CI, 1.
85 to 8.
09; P<0.
001).
During a median follow-up of 18 months, patients with CVR had a higher rate of recurrent stroke than those without CVR (13.
6%/year vs.
6.
2%/year; aOR=2.
53; 95% CI, 1.
09 to 5.
84; P=0.
03).
In summary, CVR may contribute to the formation of enlarged PVS and increase the risk of
recurrent stroke in patients with hypertensive ICH.
References:
Cerebral Venous Reflux and Dilated Basal Ganglia Perivascular Space in Hypertensive Intracerebral Hemorrhage.
DOI: https://doi.
org/10.
5853/jos.
2022.
01004
