Relationship Between White-Matter Hyperintensities and Hematoma Volume and Growth in Patients With Intracerebral Hemorrhage

Abstract

Background and Purpose— The presence of white-matter hyperintensities (WMHs) has been linked to intracerebral hemorrhage (ICH). We sought to determine whether the severity of WMHs influences hematoma growth and ICH volume. Methods— We retrospectively reviewed prospectively collected clinical, laboratory, and radiologic data from 79 consecutive ICH patients who had brain magnetic resonance imaging performed within 72 hours of ICH symptom onset. We assessed the severity of WMHs on magnetic resonance imaging on the modified Scheltens scale and performed logistic-regression analysis to examine the association between WMHs and ICH volume. We also examined the association between WMH score and hematoma growth in a subset of 34 patients who had a baseline computed tomography scan within 12 hours of ICH onset and a follow-up scan within 72 hours. Results— The ICH volume at 37.6±22.3 hours from ICH onset was 2-fold higher in patients with a high WMH score (≥14) than in those with a lower score. A high WMH score was independently associated with a larger ICH volume (odds ratio=1.152; 95% CI, 1.035 to 1.282; P =0.01). There was a trend for an association between WMH score and ICH volume growth (odds ratio=1.286; 95% CI, 0.978 to 1.692; P =0.062). Conclusion— Severe WMHs are associated with larger ICH volumes and, to a lesser extent, with hematoma growth. Our findings suggest that WMHs may provide important prognostic information on patients with ICH and may have implications for treatment stratification. These findings require prospective validation, and the links between WMHs and ICH growth require further investigations.