Comparison of intracerebral hemorrhage caused by cerebral small vessel disease and non-cerebral small vessel disease etiologies

Cerebral small vessel disease (CSVD) is the main cause of intracerebral hemorrhage (ICH). However, a substantial portion is also caused by non-CSVD etiologies, including trauma, vascular malformations and brain tumors. In this retrospective observational study, we compared factors that predispose to the onset of ICH, namely demographics, antithrombotic medication, vascular risk profile and CSVD on magnetic resonance imaging (MRI) between patients with CSVD-related ICH and non-CSVD-related ICH. In 922 patients with ICH (median age = 71), CSVD caused the majority of cases (n = 670 [73%]); non-CSVD etiologies made up the remaining quarter (n = 252 [27%]). Individuals with CSVD-related ICH had a higher prevalence of factors predisposing ICH onset compared to non-CSVD etiologies, including antithrombotic medication (34% vs. 19%), vascular risk factors (70% vs. 50%) and advanced CSVD on MRI (83% vs. 51%). However, half of non-CSVD ICH patients were either older than 60 years, had vascular risk factors or advanced CSVD, suggesting an accompanying artheriolosclerotic CSVD pathology in a substantial portion of this subgroup. Since CSVD is frequently prevalent even in non-CSVD etiologies, several factors should be taken into account to stratify an individual’s bleeding risk, although the primary pathology remains the focus for each etiology.