Clinical and radiologic differences between primary intracerebral hemorrhage with and without microbleeds on gradient-echo magnetic resonance images.
BACKGROUND
Microbleeds on gradient-echo magnetic resonance (MR) imaging reflect bleeding-prone microangiopathy. The microbleeds are frequently detected in patients with primary intracerebral hemorrhage (PICH). However, some patients do not have microbleeds.


OBJECTIVE
To clarify the risk factors associated with microbleeds in PICH, thus providing insight into the pathogenesis of PICH.


METHODS
Prospective study.


METHODS
Neurology department of a tertiary referral center. Patients A consecutive series of 107 patients with PICH.


METHODS
Gradient-echo MR imaging to determine distribution patterns and numbers of microbleeds.


METHODS
Clinical variables and the associated MR imaging abnormalities in patients with PICH with and without microbleeds.


RESULTS
Patients with PICH who had microbleeds were significantly older (65.9 +/- 10.9 years) than those without microbleeds (53.9 +/- 13.0 years; P<.001), and previous stroke, medication with antithrombotics or anticoagulants, lacunes, and leukoaraiosis were more common in patients with microbleeds. However, potential triggering events tending to raise the blood pressure were more common in cases of PICH without microbleeds (18 [56.3%] vs 10 [15.4%]). In logistic regression analysis, age (odds ratio and 95% confidence interval: 1.07, 1.01-1.14), advanced leukoaraiosis (7.79, 1.05-57.74), number of lacunes (1.66, 1.21-2.28), and potential triggering events (0.18, 0.04-0.90) were independent risk factors associated with the presence of microbleeds in patients with PICH.


CONCLUSIONS
Primary intracerebral hemorrhage without microbleeds was more common in younger patients with precipitating events, whereas PICH with microbleeds was more common in elderly patients with prominent ischemic change and frequent use of antithrombotics or anticoagulants. Our findings might help to determine the pathogenetic type for secondary prevention.
Jeong
Sang-Wuk
SW
Department of Neurology, Ilsan Paik Hospital, Inje University, Ilsan, Korea.
Jung
Keun-Hwa
KH
Chu
Kon
K
Bae
Hee-Joon
HJ
Lee
Seung-Hoon
SH
Roh
Jae-Kyu
JK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000473:pathology* / Q000503:physiopathology*; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies