A Causal Classification System for Intracerebral Hemorrhage Subtypes.

Autor: Raposo N; Department of Neurology, Toulouse University Hospital, Toulouse, France.; Toulouse NeuroImaging Center, Toulouse University, Toulouse, France., Zanon Zotin MC; Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Center for Imaging Sciences and Medical Physics, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil., Seiffge DJ; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Li Q; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China., Goeldlin MB; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Graduate School for Health Sciences, University of Bern, Bern, Switzerland., Charidimou A; Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Shoamanesh A; Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada., Jäger HR; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK., Cordonnier C; Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, Lille, France., Klijn CJ; Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands., Smith EE; Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada., Greenberg SM; Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Werring DJ; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK., Viswanathan A; Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Annals of neurology [Ann Neurol] 2023 Jan; Vol. 93 (1), pp. 16-28. Date of Electronic Publication: 2022 Nov 16.
DOI: 10.1002/ana.26519
Abstrakt: Objective: Determining the underlying causes of intracerebral hemorrhage (ICH) is of major importance, because risk factors, prognosis, and management differ by ICH subtype. We developed a new causal CLASsification system for ICH Subtypes, termed CLAS-ICH, based on recent advances in neuroimaging.
Methods: CLAS-ICH defines 5 ICH subtypes: arteriolosclerosis, cerebral amyloid angiopathy, mixed small vessel disease (SVD), other rare forms of SVD (genetic SVD and others), and secondary causes (macrovascular causes, tumor, and other rare causes). Every patient is scored in each category according to the level of diagnostic evidence: (1) well-defined ICH subtype; (2) possible underlying disease; and (0) no evidence of the disease. We evaluated CLAS-ICH in a derivation cohort of 113 patients with ICH from Massachusetts General Hospital, Boston, USA, and in a derivation cohort of 203 patients from Inselspital, Bern, Switzerland.
Results: In the derivation cohort, a well-defined ICH subtype could be identified in 74 (65.5%) patients, including 24 (21.2%) with arteriolosclerosis, 23 (20.4%) with cerebral amyloid angiopathy, 18 (15.9%) with mixed SVD, and 9 (8.0%) with a secondary cause. One or more possible causes were identified in 42 (37.2%) patients. Interobserver agreement was excellent for each category (kappa value ranging from 0.86 to 1.00). Despite substantial differences in imaging modalities, we obtained similar results in the validation cohort.
Interpretation: CLAS-ICH is a simple and reliable classification system for ICH subtyping, that captures overlap between causes and the level of diagnostic evidence. CLAS-ICH may guide clinicians to identify ICH causes, and improve ICH classification in multicenter studies. ANN NEUROL 2023;93:16-28.
(© 2022 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)
Databáze: MEDLINE
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