J Stroke.  2022 Sep;24(3):363-371. 10.5853/jos.2022.01004.

Cerebral Venous Reflux and Dilated Basal Ganglia Perivascular Space in Hypertensive Intracerebral Hemorrhage

• Tsai HH
• Lee BC
• Chen YF
• Jeng JS
• Tsai LK

• KMID: 2534265
• DOI: http://doi.org/10.5853/jos.2022.01004

Abstract

Background and Purpose
Cerebral venous flow alterations potentially contribute to age-related white matter changes, but their role in small vessel disease has not been investigated.
Methods
This study included 297 patients with hypertensive intracerebral hemorrhages (ICH) who underwent magnetic resonance imaging. Cerebral venous reflux (CVR) was defined as the presence of abnormal signal intensity in the dural venous sinuses or internal jugular vein on time-of-flight angiography. We investigated the association between CVR, dilated perivascular spaces (PVS), and recurrent stroke risk.
Results
CVR was observed in 38 (12.8%) patients. Compared to patients without CVR those with CVR were more likely to have high grade (>20 in the number) dilated PVS in the basal ganglia (60.5% vs. 35.1%; adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.25 to 5.60; P=0.011) and large PVS (>3 mm in diameter) (50.0% vs. 18.5%; aOR, 3.87; 95% CI, 1.85 to 8.09; P<0.001). During a median follow-up of 18 months, patients with CVR had a higher recurrent stroke rate (13.6%/year vs. 6.2%/year; aOR, 2.53; 95% CI, 1.09 to 5.84; P=0.03) than those without CVR.
Conclusions
CVR may contribute to the formation of enlarged PVS and increase the risk of recurrent stroke in patients with hypertensive ICH.

Keyword

Cerebral small vessel diseases; Hypertension; Cerebral hemorrhage; Perivascular space; Cerebrovenous reflux

Figure

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  Figure 1. Flowchart of patient enrolment. ICH, intracerebral hemorrhage; NTUH, National Taiwan University Hospital; MRI, magnetic resonance imaging; CMB, cerebral microbleed.

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  Figure 2. Image of representative cerebral venous reflux (CVR). CVR is detected in (A) the left internal jugular vein (arrow), (B) the left sigmoid sinus (arrow) and bilateral inferior petrosal sinuses (arrowheads), (C) the left internal jugular vein (arrow) and the left inferior petrosal sinus (arrowhead), and (D) the left transverse sinus (arrow).

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  Figure 3. Kaplan-Maier curves for patients with cerebral venous reflux (CVR) and patients without CVR. HR, hazard ratio; CI, confidence interval.

Reference

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