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Mixed-location cerebral hemorrhage/microbleeds: Underlying microangiopathy and recurrence risk

Marco Pasi1, Andreas Charidimou1, Gregoire Boulouis1

  • 1From the Hemorrhagic Stroke Research Program (M.P., A.C., G.B., E.A., A.A., K.M.S., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; NEUROFARBA Department (M.P., L.P.), Neuroscience Section, University of Florence, Italy; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.

Neurology
|December 17, 2017
PubMed
Abstract

Insights

Mixed intracerebral hemorrhage (ICH) is linked to vascular risk factors and shows severe brain damage. Patients with mixed ICH face a higher risk of stroke recurrence compared to those with hypertensive ICH.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Cerebral small vessel disease (SVD) is a common cause of intracerebral hemorrhage (ICH).
  • Distinguishing the underlying cause of ICH is crucial for predicting recurrence risk.

Purpose of the Study:

  • To evaluate the predominant SVD type and recurrence risk in patients with mixed lobar and deep ICH.
  • To compare the characteristics of mixed ICH with cerebral amyloid angiopathy (CAA-ICH) and hypertensive ICH (HTN-ICH).

Main Methods:

  • Prospective registry of 391 primary ICH patients.
  • Comparison of demographics, clinical features, and neuroimaging markers between mixed ICH (n=75), CAA-ICH (n=191), and HTN-ICH (n=125) groups.
  • Analysis of ICH recurrence and case fatality rates.

Main Results:

  • Mixed ICH patients exhibited more vascular risk factors, lacunes, and enlarged perivascular spaces compared to CAA-ICH.
  • Mixed ICH was independently associated with older age, more lacunes, and higher microbleed counts versus HTN-ICH.
  • Annual ICH recurrence risk was 5.1% for mixed ICH, lower than CAA-ICH (10.4%) but higher than HTN-ICH (1.6%).

Conclusions:

  • Mixed ICH is often associated with vascular risk factors, similar to HTN-ICH.
  • Mixed ICH demonstrates more severe parenchymal damage and a higher risk of recurrence than HTN-ICH.
  • Understanding mixed ICH is vital for accurate diagnosis and management of SVD.

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