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Published on: April 23, 2021
Incident Cerebral Microbleeds in a Cohort of Intracerebral Hemorrhage
Marta Pasquini1, Marije R Benedictus1, Grégoire Boulouis1
1From the Univ. Lille, Inserm, CHU Lille, U 1171, Degenerative and vascular cognitive disorders, Lille, France, (M.P., G.B., C.R., N.D.-P., C.C.); Department of Neurology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Saint Philibert Hospital, Lille, France (M.P.); and Alzheimer Center and, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands (M.R.B.).
Background And Purpose:
We aimed to identify prognostic and associated factors of incident cerebral microbleeds (CMBs) in intracerebral hemorrhage (ICH) survivors.
Methods:
Observational prospective cohort of 168 ICH survivors who underwent 1.5T magnetic resonance imaging at ICH onset and during follow-up (median scan interval, 3.4; interquartile range, 1.4-4.7) years. We used logistic regression adjusted for age, sex, and scan interval. Analyses were stratified according to the index ICH location (58 lobar ICH, 103 nonlobar ICH, excluding patients with multiple or unclassifiable ICH).
Results:
Eighty-nine (53%) patients had CMBs at ICH onset, and 80 (48%) exhibited incident CMBs during follow-up. Predictors of incident CMBs at ICH onset were ≥1 CMBs (adjusted odds ratio [aOR], 2.27; 95% confidence interval [CI], 1.18-4.35), old radiological macrohemorrhage (aOR, 6.78; 95% CI, 2.76-16.68), and CMBs in mixed location (aOR, 3.73; 95% CI, 1.67-8.31). When stratifying by ICH location, incident CMBs were associated in nonlobar ICH with incident lacunes (aOR, 2.86; 95% CI, 1.04-7.85) and with the use of antiplatelet agents (aOR, 2.89; 95% CI, 1.14-7.32). In lobar ICH, incident CMBs were associated with incident radiological macrohemorrhage (aOR, 9.76; 95% CI, 1.07-88.77).
Conclusions:
Prognostic and associated factors of incident CMBs differed according to the index ICH location. Whereas in lobar ICH, incident CMBs were associated with hemorrhagic biomarkers, in nonlobar ICH, ischemic burden also increased. CMBs may be interesting biomarkers to monitor in randomized trials on restarting antithrombotic drugs after ICH.
Insights
Factors predicting new cerebral microbleeds (CMBs) in stroke survivors vary by stroke location. Hemorrhagic factors are key in lobar bleeds, while ischemic factors also play a role in nonlobar bleeds.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Intracerebral hemorrhage (ICH) survivors face risks of developing new cerebral microbleeds (CMBs).
- Understanding factors associated with incident CMBs is crucial for patient management and secondary prevention strategies.
Purpose of the Study:
- To identify prognostic and associated factors of incident cerebral microbleeds (CMBs) in patients who have survived an intracerebral hemorrhage (ICH).
Main Methods:
- An observational prospective cohort study included 168 ICH survivors.
- Magnetic resonance imaging (MRI) was performed at ICH onset and during follow-up.
- Logistic regression analyses were stratified by the index ICH location (lobar vs. nonlobar).
Main Results:
- Over half of patients (53%) had CMBs at ICH onset, and 48% developed incident CMBs during follow-up.
- Predictors of incident CMBs at ICH onset included prior CMBs, old macrohemorrhage, and mixed CMB location.
- In nonlobar ICH, incident CMBs were linked to new lacunes and antiplatelet agent use.
- In lobar ICH, incident CMBs were associated with new radiological macrohemorrhage.
Conclusions:
- Prognostic and associated factors for incident CMBs differ based on the initial intracerebral hemorrhage location.
- Lobar ICH is associated with hemorrhagic biomarkers, while nonlobar ICH involves increased ischemic burden.
- Cerebral microbleeds show potential as biomarkers for monitoring in trials investigating the reintroduction of antithrombotic therapies post-ICH.
