Cerebral small vessel disease characteristics associate with domain-specific impairments during Intracerebral Hemorrhage: A retrospective cohort study

Introduction: Cerebral Small Vessel Disease (CSVD) is associated with cognitive disruptions after intracerebral hemorrhage (ICH), however evidence connecting CSVD to admission National Institutes of Health Stroke Scale (NIHSS) scores is limited. Methods: Electronic medical record data were retrieved for adult patients (>18 years) with admission for primary ICH and available NIHSS and CSVD assessment. CSVD burden was graded from 0 to 4 based on magnetic resonance imaging, with 1 point assessed for: 1) deep Fazekas score of 2-3 or periventricular (PV) Fazekas score of 3; 2) cerebral microbleed presence; 3) lacune presence; 4) > 20 basal ganglia perivascular spaces. Severe CSVD was defined as a summary score ≥ 3, and individual marker severity was assessed using the same criteria. The primary outcome was moderate-severe stroke (total NIHSS score ≥5). Secondary outcomes were severe motor deficit (motor score >12), complete aphasia (language score = 3), and cortical deficit (any impairment in language, extinction, and gaze). Associations between CSVD and NIHSS were determined using multivariable logistic regression, adjusting for major clinical and demographic factors. Adjusted odds ratios (aOR) and 95 % confidence interval (CI) are reported. Results: The cohort included 1024 patients (median age [interquartile range]: 71 [61-79], 53 % male). Patients were 43 % White, 23 % Black, 21 % Hispanic, 8 % Asian, 5 % other; 477 (47 %) showed moderate-severe NIHSS scores and 262 (26 %) showed severe CSVD. Periventricular white matter hyperintensity (WMH) burden was independently associated with moderate-severe NIHSS score (aOR, 95 % CI: 1.54, [1.02-2.33]). Deep WMH burden was independently associated with aphasia (2.02, [1.03-3.91]), and motor deficit (3.64, [1.15-12.19]). Conclusion: Severe WMH burdens independently increase odds of neurological deficit among patients with primary ICH.