EXPRESS: Idiopathic Primary Intraventricular Hemorrhage and Cerebral Small Vessel Disease.

Abstract

Backgroundâ Although primary intraventricular hemorrhage is frequently due to trauma or vascular lesions, the etiology of idiopathic primary intraventricular hemorrhage (IP-IVH) is not defined. Aimsâ Herein, we test the hypothesis that cerebral small vessel diseases (cSVD) including hypertensive cSVD (HTN-cSVD) and cerebral amyloid angiopathy (CAA) are associated with IP-IVH.Methodsâ Brain magnetic resonance imaging (MRI) from consecutive patients (January 2011 to September 2019) with non-traumatic intracerebral hemorrhage (ICH) from a single referral center were reviewed for the presence of HTN-cSVD (defined by strictly deep or mixed-location ICH/cerebral microbleeds [CMBs]) and CAA (applying modified Boston criteria).Resultsâ 46 (4%) out of 1,276 patients were identified as having IP-IVH. Among these, the mean age was 74.4 ± 12.2 years and 18 (39%) were females. 40 (87%) had hypertension, and the mean initial blood pressure was 169.2 ± 40.4/88.8 ± 22.2 mmHg. Of the 35 (76%) patients who received a brain MRI, two (6%) fulfilled the modified Boston criteria for possible CAA and 10 (29%) for probable CAA. Probable CAA was found at a similar frequency when comparing IP-IVH patients to the remaining patients with primary intraparenchymal hemorrhage (P-IPH) (27%, p = 0.85). Furthermore, imaging evidence for HTN-cSVD was found in 8 (24%) patients with IP-IVH compared to 209 (28%, p = 0.52) patients with P-IPH.Conclusionsâ Among IP-IVH patients, CAA was found in approximately one-third of patients, whereas HTN-cSVD was detected in 23%âboth similar rates to P-IPH patients. Our results suggest that both cSVD subtypes may be associated with IP-IVH.