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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/1\\\/4\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/1\\\/4\u0022}],\u0022ac\u0022:{\u0022spmdc;14\\\/1\\\/4\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;14\\\/1\\\/4\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIntracerebral hemorrhage (ICH), not related to trauma, is a significant cause of morbidity and mortality. Therapeutic options are few, and none are proven to reduce morbidity or mortality. This article discusses the epidemiology of ICH, use of neuroimaging to establish etiology and to stratify risk for nontraumatic ICH, genetic markers of ICH, as well as the the risk of ICH associated with statin therapy, nonsteroidal anti-inflammatory drugs, alcohol, selective serotonin reuptake inhibitors, and vitamin E.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EIschemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeuroimaging\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EIschemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeuroimaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIntracerebral hemorrhage (ICH), not related to trauma, is a significant cause of morbidity and mortality. Therapeutic options are few, and none are proven to reduce morbidity or mortality. Dawn Kleindorfer, MD, University of Cincinnati, Cincinnati, Ohio, USA, reviewed the epidemiology of ICH.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EICH represents \u223c10% of all strokes [Go AS et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2014] and has a 43% mortality rate at 6 months. Only 12% of patients are left with minor or no disability. The primary injury is due mainly to the mass effect of the hematoma. Symptoms often progress as the hematoma grows or when there is a rupture of the blood into the ventricles. Secondary injury is mostly associated with the effects of the blood products such as edema or inflammatory reaction. Risk factors, which vary somewhat by location of the hematoma, include advancing age, hypertension (associated with 70% of ICH; primarily deep ICH), being black or Hispanic, use of warfarin, prior ischemic stroke, and possibly family history and alcohol use. Optimal use of warfarin for atrial fibrillation is an important factor for controlling ICH risk as international normalized ratio (INR) values \u22653.4 are associated with increased risk (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Fang MC et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2004]. Other possible risk factors like cholesterol and smoking need more confirming studies.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Warfarin and INR as ICH Risk Factors\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1343314867\u0022 data-figure-caption=\u0022Warfarin and INR as ICH Risk Factors\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14316\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EWarfarin and INR as ICH Risk Factors\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EINR=international normalized ratio.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Fang MC et al. Advanced Age, Anticoagulation Intensity, and Risk for Intracranial Hemorrhage Among Patients Taking Warfarin for Atrial Fibrillation. \u003Cem\u003EAnn Int Med\u003C\/em\u003E 2004;141(10):745\u2013752. With permission from the American College of Physicians.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EThe location of an ICH is important in terms of symptom severity, outcomes, and etiology. Brainstem ICH has the least probability of survival. Hemorrhage volume, baseline Glasgow Coma Scale score, and the presence of intraventricular extension are also predictors of outcome. Small differences in hemorrhage volume can make a big difference in outcome and mortality (ie, a ping pong ball-sized hemorrhage [28 mL] has a mortality rate of 19% compared with 20% to 55% for one the size of golf ball [41 mL]).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EMahmut Gurol, MD, MSc, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA, discussed the use of neuroimaging to establish etiology and to stratify risk for nontraumatic ICH including hypertensive small vessel disease and cerebral amyloid angiopathy (CAA).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ENoninvasive imaging of brain vasculature using computed tomography and magnetic resonance (MR) angiography can identify deep hemispheric ICH in hypertensive patients with nontraumatic hemorrhage. T2* weighted MRI images are useful for identifying microbleeds in cortico-, subcortical, and lobar micro- and macro-hemorrhages. Microbleeds are common in patients with ICH, particularly lobar ICH related to CAA. Their presence is related to all clinical symptoms\/syndromes associated with underlying microvasculopathies such as cognitive impairment, ICH, and ischemic stroke. An increasing number of baseline hemorrhages can predict increased risk for subsequent cognitive impairment, loss of independence, or death [Greenberg SM et al. \u003Cem\u003EStroke\u003C\/em\u003E 2004].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ESulcal siderosis is a focal subarachnoid hemorrhage in a cortical sulcus often associated with CAA. It can be identified with gradient recalled echo and susceptibility weighted MRI. Cortical superficial siderosis (particularly if disseminated) is a common and characteristic feature of CAA and increases the risk of recurrent ICH (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Charidimou A et al. \u003Cem\u003ENeurology\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Cortical Superficial Siderosis and Risk of Intracerebral Hemorrhage in Cerebral Amyloid Angiopathy\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1343314867\u0022 data-figure-caption=\u0022Cortical Superficial Siderosis and Risk of Intracerebral Hemorrhage in Cerebral Amyloid Angiopathy\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14318\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003ECortical Superficial Siderosis and Risk of Intracerebral Hemorrhage in Cerebral Amyloid Angiopathy\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EcSS=cortical superficial siderosis; ICH=intracerebral hemorrhage.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced from Charidimou A et al. Cortical superficial siderosis and intracerebral hemorrhage risk in cerebral amyloid angiopathy. \u003Cem\u003ENeurology\u003C\/em\u003E 2013;81(19);1666\u20131673. With permission from Lipincott Williams and Wilkins.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Gurol concluded with a discussion of use of positron emission tomography imaging with Pittsburgh compound B to predict CAA related hemorrhages. Mean distribution volume ratio in a superior frontal\/parasagittal region of interest significantly (p=0.003) correlated independently with number of future hemorrhages in CAA subjects (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E) [Gurol ME et al. \u003Cem\u003ENeurology\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Pittsburgh Compound B PET Predicts CAA-Related Hemorrhages\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1343314867\u0022 data-figure-caption=\u0022Pittsburgh Compound B PET Predicts CAA-Related Hemorrhages\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14320\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \n            \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EPittsburgh Compound B PET Predicts CAA-Related Hemorrhages\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003EDVR=distribution volume ratio; PET=positron emission tomography\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-6\u0022\u003EReproduced from Gural ME et al. Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy. \u003Cem\u003ENeurology\u003C\/em\u003E 2012;79(4):320\u2013326. With permission from Lipincott Williams and Wilkins.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-12\u0022\u003EGenetic variations, such as those at apolipoprotein E (APOE) genes, are being identified that influence the risk of spontaneous ICH. In addition, two new loci have been identified that suggest a biological heterogeneity across ICH subtypes. Joan Montaner, MD, PhD, Hospital Vall d\u0027Hebron, Barcelona, Spain, discussed genetic markers of ICH risk that may identify novel pathways and prevention strategies.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EResults of a 2002 study showed that having a first-degree relative with an ICH is an independent predictor for deep ICH (OR, 6.3; 95% CI, 1.1 to 22) [Woo D et al. \u003Cem\u003EStroke\u003C\/em\u003E]. The influence of genetics is also supported by a recent study showing genetic variation having a substantial role in ICH risk, outcome, and hematoma volume [Devan WJ et al. \u003Cem\u003EStroke\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003ESingle gene disorders that play a role in ICH have also been identified. For example, a mutation in the mouse Col4a1 gene, encoding procollagen type IV alphal, predisposes both newborn and adult mice to small vessel disease and hemorrhagic stroke [Gould DB et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2006]. Among men, a polymorphism in betal-tubulin (TUBB1 Q43P) has been found to significantly increase (p=0.021) the risk of ICH and to be associated with an earlier age of occurrence (p=0.011). Carriers of the TUBB1 Q43P polymorphism have been found to display lower platelet reactivity towards collagen, but an increased risk of ICH [Navarro-Nunez L et al. \u003Cem\u003EHaematologica\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EVariants at APOE have been associated with lobar (alleles \u03b52 and \u03b54) as well as deep (allele \u03b54) ICH at a genome-wide significance level. A stronger effect was noted when analysis was restricted to definite\/probable CAA ICH (\u003Ca id=\u0022xref-fig-4-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F4\u0022\u003EFigure 4\u003C\/a\u003E) [Biffi A et al. \u003Cem\u003EAnn Neurol\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cdiv id=\u0022F4\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F4.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Impact of Variants at APOE on ICH Probability\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1343314867\u0022 data-figure-caption=\u0022Impact of Variants at APOE on ICH Probability\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 4.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F4.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F4.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 4.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F4.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14322\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 4.\u003C\/span\u003E \n            \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EImpact of Variants at APOE on ICH Probability\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-7\u0022\u003EICH=intracerebral hemorrhage.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-8\u0022\u003EReproduced from Biffi A et al. Variants at APOE influence risk of deep and lobar intracerebral hemorrhage. \u003Cem\u003EAnn Neurol\u003C\/em\u003E 2010;68(6):934\u2013943. With permission from John Wiley \u0026amp; Sons, Inc.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-17\u0022\u003EAPOE \u03b54 influences the risk of deep and lobar ICH in participants of both European ancestry and African-American descent. Carriers of APOE \u03b52 with lobar ICH have larger ICH volumes compared with noncarriers [Biffi A et al. \u003Cem\u003ELancet Neurol\u003C\/em\u003E 2011] and greater chance of ICH recurrence [Domingues-Montanari S et al. \u003Cem\u003ENeurobiol Aging\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EHypertension is a noted risk factor for ICH and several hypertensive pressure-related alleles are associated with increased risk of deep ICH as well as with clinically identified hypertension [Falcone GJ et al. \u003Cem\u003EStroke\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EThe future of ICH genetics requires a collaborative effort and new genetic tools. A number of ongoing genome-wide studies are looking at the impact of genetics on ICH. One of these is the Ethnic\/Racial Variations of Intracerebral Hemorrhage study [ERICH], a large, case-control study of ICH with particular emphasis on recruitment of minorities.\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EPhilip Gorelick, MD, MPH, Michigan State University College of Human Medicine and Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan, USA, reviewed the risk of ICH associated with statin therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, selective serotonin reuptake inhibitors (SSRIs), and vitamin E.\u003C\/p\u003E\u003Cp id=\u0022p-21\u0022\u003EHis conclusions regarding these agents were as follows:\u003C\/p\u003E\u003Cp id=\u0022p-22\u0022\u003E\n         \u003Cstrong\u003EStatins:\u003C\/strong\u003E In the SPARCL trial, there was only a slight excess of hemorrhagic stroke with atorvastatin versus placebo (2.3% vs 1.4%). If a risk exists, the absolute magnitude is likely to be small and outweighed by the advantages of statins for reduction of major vascular events. However, it remains unclear whether statins should be avoided for patients with a history of ICH, especially lobar.\u003C\/p\u003E\u003Cp id=\u0022p-23\u0022\u003E\n         \u003Cstrong\u003ENSAIDs:\u003C\/strong\u003E Concerns with NSAIDs center on risk for thrombosis and gastrointestinal bleeding but there is no apparent ICH signal. Moderate to high doses of aspirin (\u0026gt;1225 mg\/week spread over \u22653 doses) carry a high risk of ICH (OR, 3.05; 95% CI, 1.02 to 9.14; p=0.047). Nonaspirin NSAIDS are not a risk for ICH hospitalization.\u003C\/p\u003E\u003Cp id=\u0022p-24\u0022\u003E\n         \u003Cstrong\u003EAlcohol:\u003C\/strong\u003E There is a positive linear association with the number of drinks and the occurrence of ICH. Possible mechanisms include hypertension, coagulation disturbances, and activation of adrenergic receptors.\u003C\/p\u003E\u003Cp id=\u0022p-25\u0022\u003E\n         \u003Cstrong\u003ESSRIs:\u003C\/strong\u003E SSRIs may be linked to ICH but the absolute risk is small (one additional intracerebral bleeding episode\/10000 persons treated for 1 year). This may be enhanced, however, by the use of oral anticoagulants or history of ICH (particularly lobar).\u003C\/p\u003E\u003Cp id=\u0022p-26\u0022\u003E\n         \u003Cstrong\u003EVitamin E:\u003C\/strong\u003E There may be an increased risk of ICH but the absolute effects are small and vitamin E may reduce ischemic stroke risk. Vitamin E should be used with caution.\u003C\/p\u003E\u003Cdiv id=\u0022F5\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F5.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the International Stroke Conference presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1343314867\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the International Stroke Conference presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure5\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F5.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F5.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure5\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/4\/F5.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14324\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n            \u003Cp id=\u0022p-27\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the International Stroke Conference presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/1\/4.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzl561\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl561\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}