Cerebral small vessel disease in patients with spontaneous cerebellar hemorrhage

Marco Pasi, Andreas Charidimou, Gregoire Boulouis, Panagiotis Fotiadis, Andrea Morotti, Li Xiong, Sandro Marini, Alison Ayres, Matthew P. Frosch, Joshua N. Goldstein, Jonathan Rosand, M. Edip Gurol, Steven M. Greenberg, Anand Viswanathan

Research output: Contribution to journalArticlepeer-review


Background: Spontaneous cerebellar-intracerebral hemorrhage (ICH) can be associated with both cerebral amyloid angiopathy (CAA) and hypertensive small vessel disease (HTN-SVD, i.e. arteriolosclerosis). To better understand the underlying microangiopathy of cerebellar-ICH, we aimed to evaluate the spatial distribution of supratentorial cerebral microbleeds (CMBs) and neuropathologic profiles in these patients. Methods: We enrolled consecutive cerebellar-ICH patients. Clinical variables and MRI markers specific for CAA and HTN-SVD were assessed. Patients were classified into categories according to the topography (strictly-lobar, strictly-deep, and mixed) of supratentorial CMBs and comparisons were performed. Available neuropathological material was reviewed to evaluate the presence and severity of arteriolosclerosis and CAA. Results: Ninety-eight cerebellar-ICH patients were enrolled. Fifty patients (51%) had at least one supratentorial CMB. Twelve patients (12%) had strictly lobar-CMBs, 12 patients (12%) showed strictly deep-CMBs and mixed-CMBs (lobar and deep CMBs) were present in 26 cerebellar-ICH patients (27%). In multivariable analysis, cerebellar-ICH patients with mixed-CMBs were associated with higher prevalence of hypertension (OR 4.9, 95% confidence interval [CI] 1.2–20, p = 0.017) but with lower prevalence of severe centrum-semiovale enlarged perivascular spaces (OR 0.2, CI 0.05–0.8, p = 0.024) when compared to cerebellar-ICH patients with strictly lobar-CMBs. Vascular risk factors and neuroimaging characteristics were similar between strictly deep-CMBs and mixed-CMBs. Six patients had available neuropathological material for analyses and they all showed some degree of arteriolosclerosis. Conclusions: Cerebellar-ICH patients frequently show supratentorial CMBs. The mixed-CMBs pattern appears to be the most common. Our radiological and pathological results suggest that the majority of cerebellar-ICH patients harbor HTN-SVD as dominant microangiopathy.

Original languageEnglish
Pages (from-to)625-630
Number of pages6
JournalJournal of Neurology
Issue number(3)
Publication statusPublished - 2019


  • Cerebellar-ICH
  • Microbleeds
  • Small vessel disease

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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