Journal Article10.1212/wnl.0000000000207977
Cadmus
Martina B. Goeldlin,M. Mueller,Bernhard M. Siepen,Wenpeng Zhang,Hatice Ozkan,Martina Locatelli,Yang Du,Waldo Valenzuela,Piotr Radojewski,Arsany Hakim,Johannes Kaesmacher,T. Meinel,Leander Clenin,Mattia Branca,Davide Strambo,T. Fischer,Friedrich Medlin,Nils Peters,Emmanuel Carrera,K. Lovblad,G M Karwacki,Carlo W. Cereda,Julien Niederhauser,Marie-Luise Mono,A. Mueller,Susanne Wegener,Sabine Sartoretti,A. Polymeris,Valerian L Altersberger,M. Katan,Marios Psychogios,Rolf Sturzenegger,C. Nauer,Michael Schaerer,Carlos Buitrago Tellez,S. Renaud,Katharina Minkner Klahre,W. Z'Graggen,David Bervini,Leo H. Bonati,Roland Wiest,Marcel Arnold,Rob J Simister,Duncan Wilson,H. Jäger,Urs Fischer,David J. Werring,David J. Seiffge +47 more
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TL;DR: CADMUS, a novel MRI-based classification for SVD-associated ICH, is feasible and reproducible and may improve the classification of ICH subtypes in clinical practice and research.
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Abstract: Background and Objectives Cerebral small vessel disease (SVD) is the major cause of intracerebral hemorrhage (ICH). There is no comprehensive, easily applicable classification of ICH subtypes according to the presumed underlying SVD using MRI. We developed an MRI-based classification for SVD-related ICH. Methods We performed a retrospective study in the prospectively collected Swiss Stroke Registry (SSR, 2013–2019) and the Stroke InvestiGation in North And central London (SIGNAL) cohort. Patients with nontraumatic, SVD-related ICH and available MRI within 3 months were classified as Cerebral Amyloid angiopathy (CAA), Deep perforator arteriopathy (DPA), Mixed CAA-DPA, or Undetermined SVD using hemorrhagic and nonhemorrhagic MRI markers (CADMUS classification). The primary outcome was inter-rater reliability using Gwet's AC1. Secondary outcomes were recurrent ICH/ischemic stroke at 3 months according to the CADMUS phenotype. We performed Firth penalized logistic regressions and competing risk analyses. Results The SSR cohort included 1,180 patients (median age [interquartile range] 73 [62–80] years, baseline NIH Stroke Scale 6 [2–12], 45.6% lobar hematoma, systolic blood pressure on admission 166 [145–185] mm Hg). The CADMUS phenotypes were as follows: mixed CAA-DPA (n = 751 patients, 63.6%), undetermined SVD (n = 203, 17.2%), CAA (n = 154, 13.1%), and DPA (n = 72, 6.3%), with a similar distribution in the SIGNAL cohort (n = 313). Inter-rater reliability was good (Gwet's AC1 for SSR/SIGNAL 0.69/0.74). During follow-up, 56 patients had 57 events (28 ICH, 29 ischemic strokes). Three-month event rates were comparable between the CADMUS phenotypes. Discussion CADMUS, a novel MRI-based classification for SVD-associated ICH, is feasible and reproducible and may improve the classification of ICH subtypes in clinical practice and research.
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Citations
Intracerebral haemorrhage — mechanisms, diagnosis and prospects for treatment and prevention
David Seiffge,Simon Fandler‐Höfler,Yang Du,Martina Goeldlin,Wilmar M.T. Jolink,Catharina J.M. Klijn,David J. Werring +6 more
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Diagnostic accuracy and radiological validation of intracerebral hemorrhage diagnosis in the Swedish Stroke Register (Riksstroke)
Gabriella Sultani,Amir Hillal,Birgitta Ramgren,Trine Apostolaki‐Hansson,Bo Norrving,Johan Wassélius,Teresa Ullberg +6 more
TL;DR: At radiological evaluation, 92.8% of ICH diagnoses in RS were consistent with spontaneous ICH, yielding a high rate of agreement that strengthens the validity of the diagnostic accuracy in the register, justifying the use of high coverage quality register data for epidemiological purposes.
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Intrazerebrale Blutungen – ein Update
Simon Jung,David Seiffge +1 more
TL;DR: Intracerebral hemorrhages, a neurological emergency caused by intracranial vessel rupture, significantly contribute to high mortality and morbidity in neurovascular diseases, accounting for approximately 15% of strokes with increasing incidence and often indistinguishable from ischemic strokes without imaging.
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