Abstract
Background and Purpose: Cerebral microbleeds are an intracerebral microangiopathy with bleeding tendency found in intracerebral hemorrhage patients. However, studies about cerebral microbleed effects on the prognosis of hypertensive intracerebral hemorrhage patients are rare. We performed a prospective study to discuss not only the risk factors of cerebral microbleed incidence in hypertensive intracerebral hemorrhage patients but also the relevance of cerebral microbleeds with silent brain infarction, hemorrhage and prognosis.Methods: This study enrolled 100 patients diagnosed with hypertensive intracerebral hemorrhage within 3 days after onset. Magnetic resonance imaging including susceptibility-weighted imaging and diffusion-weighted imaging (DWI) were utilized to examine patients on the fifth day after onset. Regular follow-ups were performed to examine the following clinical cerebrovascular events and vascular deaths in 1 year.Results: Cerebral microbleeds were observed in 55 (55%) patients. Multiple logistic regression analysis showed that over-aging, elevation of serum creatinine, and leukoaraiosis were independently associated with cerebral microbleeds. In addition, higher silent brain infarction prevalence was observed in patients with cerebral microbleeds. In contrast, none of the cerebral microbleed patients exhibited cerebral microbleeds ≥5, which is an independent risk factor of poor 3-month neurological function recovery. During the 1-year follow-up, 14 subjects presented clinical cerebrovascular events or vascular death. The Cox proportional hazards model implicated that atrial fibrillation, cerebral microbleeds ≥5 and silent brain infarction were independent predictive factors for these events.Conclusions: Over-aging combined with an elevation of serum creatinine and leukoaraiosis were independent risk factors of cerebral microbleeds. Patients with cerebral microbleeds were more likely to exhibit silent brain infarction. Poor recovery of 3-month neurological function was observed in hypertensive intracerebral hemorrhage patients with cerebral microbleeds ≥5. Cerebral microbleeds ≥5 or silent brain infarction might also indicate an elevated risk of future cerebrovascular events and vascular death.
Highlights
Spontaneous intracerebral hemorrhage occurs at an incidence of 10∼30% of first-ever strokes, and 30∼55% of patients reach mortality in 1 month (Balami and Buchan, 2012; Tsai et al, 2013)
The exclusion criteria were as follows: intracerebral hemorrhages (ICHs) secondary to cerebral tumor; with the possibility to be intracranial hemorrhage related with cerebral amyloid angiopathy (Knudsen et al, 2001); ICH due to abnormal brain structure; moyamoya disease; intracranial ruptured aneurysms; hemorrhage caused by craniocerebral trauma; haematemesis or taking an anticoagulant drug; with contraindications for MRI, pregnant women, or subjects who refused to participate in the study
Of 130 patients screened, 30 among them were excluded for the reasons below: 11 patients for more than 3 days from onset, 8 for cerebral amyloid angiopathy based on the Boston diagnostic criteria, 5 for trauma, 3 for tumors, 2 for rejection of participation and 1 for the contraindication of MRI
Summary
Spontaneous intracerebral hemorrhage occurs at an incidence of 10∼30% of first-ever strokes, and 30∼55% of patients reach mortality in 1 month (Balami and Buchan, 2012; Tsai et al, 2013). The incidence of CMBs in ICH patients can reach 50∼80% (Greenberg et al, 2004; Jeong et al, 2004; Imaizumi et al, 2008), which is much higher than the 15∼35% observed in cerebral infarction patients (Fiehler et al, 2007; Yamada et al, 2012). Studies about cerebral microbleed effects on the prognosis of hypertensive intracerebral hemorrhage patients are rare. We performed a prospective study to discuss the risk factors of cerebral microbleed incidence in hypertensive intracerebral hemorrhage patients and the relevance of cerebral microbleeds with silent brain infarction, hemorrhage and prognosis
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