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Pronostic vasculaire au long cours des patients après une hémorragie intracérébrale

Abstract : Background: Spontaneous (non-traumatic) intracerebral hemorrhage (ICH) is the mostdramatic type of stroke being responsible for the majority of mortality and stroke related disability. Survivors are at high risk of major vascular events, nevertheless, data on long-term prognosis after ICH are scarce. The main objective was to study long term cerebral and extra-cerebral vascular prognosis after ICH.Methods: We included patients from the PITCH (Prognosis of Intra Cerebral Haemorrhage) cohort which is a prospective and observational study that included consecutive adults admitted at the Lille University Hospital for spontaneous ICH between 2004 and 2009. We aimed to determine (i) cumulative incidence of major ischemic and hemorrhagic vascular events and their clinical and radiological predictors;(ii) the prevalence of cortical superficial siderosis (cSS) and its associated factors; (iii) the impact of cerebral microbleeds on ICH recurrence.Results: We showed that ICH survivors are at high risk of major cerebral and extracerebralvascular events. Ischemic risk overwhelmed the hemorrhagic one on long term,particularly in deep index ICH. Concerning recurrent ICH, we found that in our cohort,one out of five patients had cSS on baseline MRI and its presence was a strong predictorof recurrent ICH, suggesting the implication of underlying cerebral amyloid angiopathy.Global burden of microbleeds was also associated with higher rate of ICH recurrence.Conclusion: These findings have immediate clinical relevance and suggest that ICH survivors should benefit of a long-term and multidisciplinary follow-up. These results may also provide additional information on the risk of major ischemic and hemorrhagicevents after ICH and on radiological predictors of recurrence risk.
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Barbara Casolla. Pronostic vasculaire au long cours des patients après une hémorragie intracérébrale. Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2019. Français. ⟨NNT : 2019LIL2S026⟩. ⟨tel-02506432⟩

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