title: Predicting symptomatic intracerebral hemorrhage versus lacunar disease in patients with longstanding hypertension.
abstract: OBJECTIVE
  Hypertension results in a spectrum of subcortical cerebrovascular disease. It is unclear why some individuals develop ischemia and others develop hemorrhage. Risk factors may differ for each population. We identify factors that predispose an individual to subcortical symptomatic intracerebral hemorrhage (sICH) compared with ischemia.
  
  
  METHODS
  Demographic and laboratory data were prospectively collected for hypertensive patients presenting with ischemic stroke or sICH during an 8.5-year period. Neuroimaging was retrospectively reviewed for acute (subcortical lacunes [<2.0 cm] versus subcortical sICH) and chronic (periventricular white matter disease and cerebral microbleeds) findings. We evaluated the impact of age, race, sex, serum creatinine, erythrocyte sedimentation rate, low-density lipoprotein, presence of periventricular white matter disease or cerebral microbleeds, and other factors on the risk of sICH versus acute lacune using multivariate logistic regression.
  
  
  RESULTS
  Five hundred seventy-one patients had subcortical pathology. The presence of cerebral microbleeds (adjusted odds ratio [OR], 3.39; confidence interval [CI], 2.09-5.50) was a strong predictor of sICH, whereas severe periventricular white matter disease predicted ischemia (OR, 0.56 risk of sICH; CI, 0.32-0.98). This association was strengthened when the number of microbleeds was evaluated; subjects with >5 microbleeds had an increased risk of sICH (OR, 4.11; CI, 1.96-8.59). It remained significant when individuals with only cortical microbleeds were removed (OR, 1.77, CI, 1.13-2.76). An elevated erythrocyte sedimentation rate (OR, 1.19 per 10 mm/h increase; CI, 1.06-1.34) was significantly associated with sICH, whereas low-density lipoprotein was associated with ischemic infarct (OR, 0.93 risk of sICH per 10 mg/dL increase; CI, 0.86-0.99).
  
  
  CONCLUSIONS
  Subclinical pathology is the strongest predictor of the nature of subsequent symptomatic event. Low-density lipoprotein and erythrocyte sedimentation rate may also have a role in risk stratification.
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (E.B.M., R.F.G., A.E.H., R.H.L.); and Departments of Neurology (E.B.M., R.F.G., E.L., R.H.L.) and Clinical Practice (J.M.), Johns Hopkins Bayview Medical Center, Baltimore, MD. ebmarsh@jhmi.edu.
authors.forename: Elisabeth B
authors.initials: EB
authors.lastname: Marsh
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (E.B.M., R.F.G., A.E.H., R.H.L.); and Departments of Neurology (E.B.M., R.F.G., E.L., R.H.L.) and Clinical Practice (J.M.), Johns Hopkins Bayview Medical Center, Baltimore, MD.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (E.B.M., R.F.G., A.E.H., R.H.L.); and Departments of Neurology (E.B.M., R.F.G., E.L., R.H.L.) and Clinical Practice (J.M.), Johns Hopkins Bayview Medical Center, Baltimore, MD.
authors.forename: Argye E
authors.initials: AE
authors.lastname: Hillis
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (E.B.M., R.F.G., A.E.H., R.H.L.); and Departments of Neurology (E.B.M., R.F.G., E.L., R.H.L.) and Clinical Practice (J.M.), Johns Hopkins Bayview Medical Center, Baltimore, MD.
authors.forename: Joyce
authors.initials: J
authors.lastname: Maygers
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (E.B.M., R.F.G., A.E.H., R.H.L.); and Departments of Neurology (E.B.M., R.F.G., E.L., R.H.L.) and Clinical Practice (J.M.), Johns Hopkins Bayview Medical Center, Baltimore, MD.
authors.forename: Erin
authors.initials: E
authors.lastname: Lawrence
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (E.B.M., R.F.G., A.E.H., R.H.L.); and Departments of Neurology (E.B.M., R.F.G., E.L., R.H.L.) and Clinical Practice (J.M.), Johns Hopkins Bayview Medical Center, Baltimore, MD.
authors.forename: Rafael H
authors.initials: RH
authors.lastname: Llinas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001799:Blood Sedimentation; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D020300:Intracranial Hemorrhages / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D044469:Racial Groups; D012189:Retrospective Studies; D012737:Sex Factors; D059409:Stroke, Lacunar / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000503:physiopathology
chemical_list: D008077:Lipoproteins, LDL; D003404:Creatinine
keywords: cerebral hemorrhage; hypertension; inflammation; stroke