Retinopathy and Lobar Intracerebral Hemorrhage Insights Into Pathogenesis

Background: The vascular pathogenesis underlying lobar intracerebral hemorrhage (ICH) is unclear. Objective: To determine whether certain retinal microvascular signs are associated with lobar ICH to improve understanding of its underlying cerebral vasculopathy. Design: Prospective cohort study. Setting: Royal Melbourne Hospital and Westmead Hospital. Patients: Of 655 patients with acute stroke, 25 had lobar ICH, 51 had deep ICH, 93 had lacunar infarction, and 486 had nonlacunar cerebral infarction. Main Outcome Measures: Retinal photographs were assessed for retinopathy lesions (microaneurysms, retinal hemorrhages, cotton-wool spots, and hard exudates) and retinal arteriolar wall signs (focal arteriolar narrowing, arteriovenous nicking, and enhanced arteriolar wall light reflex) masked to the cerebral pathologic abnormalities and the study hypothesis. Results: In patients without diabetes mellitus, retinopathy lesions were more likely to be present in persons with lobar ICH than in those with either lacunar infarction (47.8% vs 30.4%; adjusted odds ratio, 3.5; 95% confidence interval, 1.1-10.9) or nonlacunar cerebral infarction (47.8% vs 24.6%; 3.3; 1.4-8.1). Most retinal arteriolar wall signs were less frequent in lobar ICH than in deep ICH, although this difference was significant only for focal arteriolar narrowing. Conclusions: Patients with lobar ICH were more likely than patients with lacunar or nonlacunar cerebral infarction to have retinopathy lesions, suggesting breakdown of the blood-retina barrier in patients with lobar ICH. These findings support a distinct vasculopathy in lobar ICH compared with other acute stroke subtypes resulting from cerebral small vessel disease or ischemic infarction.