Ongoing Microinfarction in Patients with Intracerebral Hemorrhage (S23.002)

Abstract

Objective: To determine whether cerebral microinfarcts (CMI) occur beyond the acute post-hemorrhage time window in patients with intracerebral hemorrhage (ICH). Background Clinically silent CMIs have been observed with high incidence on diffusion weighted imaging (DWI) of patients with primary ICH. Most CMIs have been detected shortly after acute hemorrhage, raising the question of whether CMIs are solely a byproduct of the acute ICH or rather are an ongoing process occurring throughout the course of severe small vessel disease. Design/Methods: We retrospectively analyzed 476 MRI scans obtained in the acute (≤7 days after ICH) or nonacute (>14 days after ICH) phases from 117 subjects with deep and 293 with lobar ICH (53% males, mean age 72.1±13.3 years). DWI, apparent diffusion coefficient maps, FLAIR and T2* MRIs were reviewed for the presence of CMIs. Results: One or more CMIs were identified in 24 (12.5%) of 192 subjects in the nonacute phase and 43 (19.7%) of 218 subjects in the acute post-ICH phase (risk ratio for CMIs on acute vs nonacute scans 1.58, 95%CI 0.99-2.5, p=0.06). Separate analyses of lobar and deep ICH yielded similar risk ratios for CMIs on acute vs nonacute images (RR= 1.46, 95%CI 0.86-2.5, p=0.2 for lobar ICH, RR= 1.94, 95%CI 0.76-4.98, p=0.21 for deep). In paired analysis of 66 subjects with both acute and nonacute MRIs, CMIs were present on 8 acute and 9 nonacute scans (RR= 0.98, 95%CI 0.71-1.36, p=1). The overall proportion of subjects with incident CMIs was 16% for lobar and 17% for deep ICH patients (p=0.77). Conclusions: Incident CMIs appear to occur commonly throughout the course of primary ICH. Although the data suggest these lesions may be more common in the acute post-ICH phase, CMIs are also frequent nonacutely, suggesting they might contribute to small vessel-related cognitive impairment. Disclosure: Dr. Auriel has nothing to disclose. Dr. Gurol has nothing to disclose. Dr. Ayres has nothing to disclose. Dr. Schwab has nothing to disclose. Dr. Vashkevich has nothing to disclose. Dr. Rosand has nothing to disclose. Dr. Viswanathan has received personal compensation for activities with Athena Diagnostics. Dr. Greenberg has received personal compensation for activities with Hoffman-Laroche Ltd. as a committee member.