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Stroke. 2012 Aug;43(8):2120-5. doi: 10.1161/STROKEAHA.112.659094. Epub 2012 May 23.

Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage.

Author information

1
Center for Human Genetic Research-Rosand Lab, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. brouwers@chgr.mgh.harvard.edu

Abstract

BACKGROUND AND PURPOSE:

The CT angiography (CTA) spot sign predicts hematoma expansion and poor outcome in patients with primary intracerebral hemorrhage (ICH). The biological underpinnings of the spot sign remain poorly understood; it may be that the underlying vasculopathy influences its presence. Therefore, we conducted a study to identify genetic predictors of the spot sign.

METHODS:

In an ongoing prospective cohort study, we analyzed 371 patients with CTA and genetic data available. CTAs were reviewed for the spot sign by 2 experienced readers, blinded to clinical data, according to validated criteria. Analyses were stratified by ICH location.

RESULTS:

In multivariate analysis, patients on warfarin were more likely to have a spot sign regardless of ICH location (OR, 3.85; 95% CI, 1.33-11.13 in deep ICH and OR, 2.86; 95% CI, 1.33-6.13 in lobar ICH). Apolipoprotein E ε2, but not ε4, was associated with the presence of a spot sign in lobar ICH (OR, 2.09; 95% CI, 1.05-4.19). There was no effect for ε2 or ε4 in deep ICH.

CONCLUSIONS:

Patients with ICH on warfarin are more likely to present with a spot sign regardless of ICH location. Among patients with lobar ICH, those who possess the apolipoprotein E ε2 allele are more likely to have a spot sign. Given the established relationship between apolipoprotein E ε2 and vasculopathic changes in cerebral amyloid angiopathy, our findings suggest that both hemostatic factors and vessel pathology influence spot sign presence.

PMID:
22621984
PMCID:
PMC3426364
DOI:
10.1161/STROKEAHA.112.659094
[Indexed for MEDLINE]
Free PMC Article

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