title: Incidence of symptomatic hemorrhage in patients with lobar microbleeds.
abstract: OBJECTIVE
  Lobar microbleeds suggestive of cerebral amyloid angiopathy (CAA) are often identified on MRI in the absence of lobar intracerebral hemorrhage (ICH). We compared the baseline characteristics and risk of subsequent ICH among such patients to those presenting with CAA-related lobar ICH.
  
  
  METHODS
  Clinical data (demographics, risk factors), apolipoprotein E genotype, neuroimaging markers of CAA severity (microbleed counts, leukoaraiosis volume), and clinical outcomes (incidence rates of ICH and death during a mean follow-up of 5.3±3.8 years) were compared between 63 patients enrolled because of incidentally found microbleeds and 316 with CAA-related ICH, in our prospectively enrolled cohort. Predictors of incident ICH were explored in the microbleed-only patients using multivariable Cox regression models.
  
  
  RESULTS
  Microbleed-only patients shared similar demographic, apolipoprotein E, and vascular risk profiles with lobar ICH patients, but had more lobar microbleeds (median, 10 versus 2; P<0.001) and higher leukoaraiosis volumes (median, 31 versus 23 mL; P=0.02). Microbleed-only patients had a nontrivial incidence rate of ICH, not different from patients presenting with ICH (5 versus 8.9 per 100 person-years; adjusted hazard ratio, 0.58; 95% confidence interval, 0.31-1.06; P=0.08). Microbleed-only patients had a higher mortality rate (hazard ratio, 1.67; 95% confidence interval, 1.1-2.6) compared with ICH survivors. Warfarin use and increasing age were independent predictors of future ICH among microbleed-only patients after correction for other covariates.
  
  
  CONCLUSIONS
  Patients presenting with isolated lobar microbleeds on MRI have a genetic, neuroimaging, and hemorrhagic risk profile suggestive of severe CAA pathology. They have a substantial risk of incident ICH, potentially affecting decisions regarding anticoagulation in clinical situations.
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Ellis S
authors.initials: ES
authors.lastname: van Etten
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Eitan
authors.initials: E
authors.lastname: Auriel
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Kellen E
authors.initials: KE
authors.lastname: Haley
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Ayres
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vashkevich
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Schwab
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.affiliation: From the Department of Neurology, Massachusetts General Hospital, Boston. edip@mail.harvard.edu.
authors.forename: M Edip
authors.initials: ME
authors.lastname: Gurol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001057:Apolipoproteins E / Q000235:genetics; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D001057:Apolipoproteins E
keywords: cerebral amyloid angiopathy; cerebral hemorrhage; cerebral microbleeds; magnetic resonance imaging