• Vaibhav Vagal, Simone U Venema, Tyler P Behymer, Eva A Mistry, Padmini Sekar, Russell P Sawyer, Lee Gilkerson, Charles J Moomaw, Mary Haverbusch, Elisheva R Coleman, Matthew L Flaherty, Carson Van Sanford, Robert J Stanton, Christopher Anderson, Jonathan Rosand, and Daniel Woo.
• University of Cincinnati, Department of Neurology, Cincinnati, Ohio. Electronic address: vagalvv@mail.uc.edu.
• J Stroke Cerebrovasc Dis. 2020 May 1; 29 (5): 104661.

BackgroundIntraventricular hemorrhage (IVH) and white matter lesion (WML) severity are associated with higher rates of death and disability in intracerebral hemorrhage (ICH). A prior report identified an increased risk of IVH with greater WML burden but did not control for location of ICH. We sought to determine whether a higher degree of WML is associated with a higher risk of IVH after controlling for ICH location.MethodsUtilizing the patient population from 2 large ICH studies; the Genetic and Environmental Risk Factors for Hemorrhagic Stroke (GERFHS III) Study and the Ethnic/Racial Variations of Intracerebral Hemorrhage study, we graded WML using the Van Swieten Scale (0-1 for mild, 2 for moderate, and 3-4 for severe WML) and presence or absence of IVH in baseline CT scans. We used multivariable regression models to adjust for relevant covariates.ResultsAmong 3023 ICH patients, 1260 (41.7%) had presence of IVH. In patients with IVH, the proportion of severe WML (28.6%) was higher compared with patients without IVH (21.8%) (P < .0001). Multivariable analysis demonstrated that moderate-severe WML, deep ICH, and increasing ICH volume were independently associated with presence of IVH. We found an increased risk of IVH with moderate-severe WML (OR = 1.38; 95%Cl 1.03-1.86, P = .0328) in the subset of lobar hemorrhages.ConclusionsModerate to severe WML is a risk for IVH. Even in lobar ICH hemorrhages, severe WML leads to an independent increased risk for ventricular rupture.Published by Elsevier Inc.

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