Relationship Between White Matter Lesions And Hematoma Expansion In Early Stage Of Spontaneous Intracerebral Hemorrhage

BackgroundSpontaneous intracerebral hemorrhage(sICH)is a kind of cerebrovascular disease with high morbidity,but limited treatment.The causes include hypertension,amyloidosis and other cerebrovascular diseases.The prognosis of patients is often related to the volume of hematoma,and early enlargement of hematoma is a predictor of poor prognosis.Existing studies suggest that one of the mechanisms of hematoma enlargement is that the primary hematoma compresses surrounding tissues,resulting in secondary vascular injury,which is called "avalanche".White matter lesions are often described as low density on CT or white matter hyperintensity on MRI in paraventricular or central semioval regions.Its etiology is unclear,and pathological manifestations are demyelination,axonal loss and so on.The pathogenesis is complex.It is believed that it may be related to chronic white matter ischemia,blood-brain barrier damage and vascular endothelial dysfunction.Previous studies of angiogenesis in patients with CADASIL(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)revealed that there was angiogenesis around white matter lesions.The damage of blood-brain barrier,change of vascular endothelial function and angiogenesis around the lesion may constitute a different microenvironment from the normal brain tissue.When white matter lesion is compressed by hematoma,the risk of vascular rupture might change,and whether the risk of hematoma expansion in the early stage of intracerebral hemorrhage will change remains to be explored.In current studies,there is no consensus on the relationship between the severity of white matter lesions and the risk of hematoma expansion.Whether there is a change in the risk of hematoma expansion when the hematoma occurs in or around the white matter lesion remains unknown.ObjectivesThe purpose of this study was to explore the relationship between the severity of white matter lesions and the risk of hematoma expansion in spontaneous intracerebral hemorrhage,and to explore whether the spatial relationship between white matter lesions and hematoma in intracerebral hemorrhage affects the risk of hematoma expansion.MethodsWe retrospectively include 130 spontaneous intracerebral hemorrhage patients hospitalized in single center from August 2016 to August 2018.Their medical history,physical examination,imaging data and laboratory examination data were collected.All patients underwent CT examination within 6 hours of onset,and follow-up CT scan would within 30 hours after the first one.Analyze 12.0 software was used to measure the volume of hematoma and edema,and the white matter lesions were evaluated by visual rating scale.Results130 patients with spontaneous supratentorial intracerebral hemorrhage were included in the final data analysis.88 patients(67.7%)were male,with an average age of 63.9±13.4 years.The prevalence of hypertension was 83.8%.36 patients(27.7%)had early enlargement of hematoma.Thirty-eight patients(29.2%)had mild to severe white matter lesions.In baseline CT of 24 patients,the hematoma contacted the white matter lesion area.By univariate analysis,it was found that the enlargement of hematoma was significantly correlated with the contact between hematoma and white matter lesion,but not with the severity of white matter lesion.In addition,the systolic blood pressure(183.1±30.3 vs.166.7±28.6 P=0.005)and diastolic blood pressure(108.4±17.3 vs.98.5±16.5 P=0.003)in enlarged hematoma group were significantly higher than those in non-enlarged hematoma group.Multivariate Logistic regression analysis showed that male(OR=3.24,95%CI=1.19-8.88),admission diastolic pressure(OR=1.03,95%CI=1.01-1.06),prothrombin time(OR=1.44,95%CI=1.03-2.03)and exposure of hematoma to white matter lesions(OR=2.84,95%CI 1.06-7.57)are independent risk factors for hematoma enlargement.ConclusionsThe severity of white matter lesions was not related to the early enlargement of hematoma in spontaneous supratentorial intracerebral hemorrhage.But location relationship between hematoma and white matter lesions was significantly related to the risk of enlargement of hematoma.