Prognostic value of apolipoprotein E genotyping in primary intracerebral hemorrhage

Background: Primary intracerebral hemorrhage (PICH) constitutes 15% of strokes. It is not a random event, but rather the result of a specific underlying vascular process such as hypertensive vasculopathy or the increasingly recognized entity of cerebral amyloid angiopathy (CAA). Conflicting reports in the literature exist with regard to association of apolipoprotein E (apoE) alleles and primary intracerebral hemorrhage (PICH). Objective: To evaluate the role of apoE, and its protein products (apoE isoforms) as a prognostic risk factor for PICH. Methods: This study was carried out on 75 patients with PICH who attended the Neurology Department, Tanta University Hospital. Patients were divided into 2 groups; group A consisted of 57 hypertensive patients and group B consisted of 18 non- hypertensive patients. Fifteen age- and sex- matched healthy controls were included. Each case was assessed to determine clinical, laboratory and neuroimaging criteria at the onset of the stroke and three months later. Results: Carriers of apoE ε2 and apoE ε4 genotype were significantly at risk of developing PICH. Also, it was found that apoE ε4 genotype in particular was significantly associated with lobar location of the hematoma and poor functional outcome at the end of the follow up period. Conclusion: ApoE ε4 is significantly associated with lobar ICH and has a poor prognostic correlation regarding functional outcome.