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The related main theme: A. Stroke and Cerebral vascular disorders

Lobar Microbleed is Associated with Poor Outcome in Deep Intracerebral Hemorrhage


Hsin-Hsi  Tsai, MD 1, 2 , Szu-Ju  Chen, MD 1, 2 , Li-Kai  Tsai, PhD, MD 2 , Yen-Ling  Lo,  1 , Ya-Fang  Chen, MD 3 , Sung-Chun  Tang, PhD, MD 2 , Jiann-Shing  Jeng, PhD, MD 2 , 
1 Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
2 Departments of Neurology, National Taiwan University Hospital, Taipei, Taiwan
3 Departments of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
Corresponding Author:

Hsin-Hsi   Tsai

keywords: Intracerebral hemorrhage; Microbleed; Small vessel disease; Hypertension
Abstract for original article

Lobar cerebral microbleeds (CMB) are frequently found in patients with deep intracerebral hemorrhages (ICH) but their significance is unclear. We aimed to explore the impact of lobar CMBs on the severity of brain injury and prognosis in patients with deep ICH.

Patients with first-ever supratentorial deep ICH from a prospectively maintained single-center registry were analyzed. Demographics, risk factors and neuroimaging markers of small vessel disease were compared between patients with lobar CMBs and those without. The follow-up data were analyzed for ICH recurrence, ischemic stroke (IS), poor functional outcome (defined as modified Rankin Scale 5 and 6) and all-cause mortality.

Of 230 patients, 106 (46.1%) had lobar CMBs and they were older (64.6 ± 12.1 vs. 58.6±12.0, p<0.001) and more likely to be hypertensive (99.1% vs. 91.9%, p=0.012) than patients without lobar CMBs. The presence of deep CMBs, lacunes, high-degree basal ganglia enlarged perivascular space (BG-EPVS) and white matter hyperintensities (WMH) were more common in patients with lobar CMBs (all p<0.05). The presence of lobar CMBs was independently associated with the presence of deep CMBs (odds ratio 3.6, 95% CI: 1.8-7.3, p<0.001), high grade BG-EPVS (odds ratio 2.1, 95% CI: 1.1-4.0, p<0.001) and higher WMH volume (odds ratio 1.4 per 10mL, 95% CI:1.1-1.7, p=0.009) and higher WMH (OR=4.1, 95% CI 1.8-9.6, p=0.001). During a median follow-up of 17 months, ICH recurrence rates were similar between groups, but higher rate of IS (4.6 vs 0.5 per 100-person-year, p=0.035) and poor functional outcome (10.8 vs 2.3 per 100-person-year, p=0.014) were observed in patients with lobar CMB. In a cox regression model, lobar CMB remained independently associated with poor functional outcome (p=0.015) after adjustment for age, sex, and other relevant SVD markers.

Presence of lobar CMBs in patients with deep ICH is associated with more severe brain injury and poor prognosis, suggesting a more advanced vasculopathy compared to patients with strictly deep ICH.