Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds

Abstract

Objective:We evaluated recurrent intracerebral hemorrhage (ICH) risk in ICH survivors, stratified by the presence, distribution, and number of cerebral microbleeds (CMBs) on MRI (i.e., the presumed causal underlying small vessel disease and its severity).Methods:This was a meta-analysis of prospective cohorts following ICH, with blood-sensitive brain MRI soon after ICH. We estimated annualized recurrent symptomatic ICH rates for each study and compared pooled odds ratios (ORs) of recurrent ICH by CMB presence/absence and presumed etiology based on CMB distribution (strictly lobar CMBs related to probable or possible cerebral amyloid angiopathy [CAA] vs non-CAA) and burden (1, 2–4, 5–10, and >10 CMBs), using random effects models.Results:We pooled data from 10 studies including 1,306 patients: 325 with CAA-related and 981 CAA-unrelated ICH. The annual recurrent ICH risk was higher in CAA-related ICH vs CAA-unrelated ICH (7.4%, 95% confidence interval [CI] 3.2–12.6 vs 1.1%, 95% CI 0.5–1.7 per year, respectively; p = 0.01). In CAA-related ICH, multiple baseline CMBs (versus none) were associated with ICH recurrence during follow-up (range 1–3 years): OR 3.1 (95% CI 1.4–6.8; p = 0.006), 4.3 (95% CI 1.8–10.3; p = 0.001), and 3.4 (95% CI 1.4–8.3; p = 0.007) for 2–4, 5–10, and >10 CMBs, respectively. In CAA-unrelated ICH, only >10 CMBs (versus none) were associated with recurrent ICH (OR 5.6, 95% CI 2.1–15; p = 0.001). The presence of 1 CMB (versus none) was not associated with recurrent ICH in CAA-related or CAA-unrelated cohorts.Conclusions:CMB burden and distribution on MRI identify subgroups of ICH survivors with higher ICH recurrence risk, which may help to predict ICH prognosis with relevance for clinical practice and treatment trials.

Microbleed prevalence and burden in anticoagulant‐associated intracerebral bleed

“…The observed CMB prevalence of~50% is significantly higher than the frequency reported in population-based studies [12][13][14] and studies in ischemic stroke patients 3 which range from 8.8 to 23%, with tendency to increase with age. However, this prevalence is comparable or lower than CMB frequency reported in ICH cohorts which often exceeds 60%, 15 using similar MRI strength and technique. This finding is counterintuitive, as one would expect higher prevalence of cerebral hemorrhagic complications, including CMBs, in those exposed to oral anticoagulation.…”

Statins and the risk of intracerebral haemorrhage in patients with stroke: systematic review and meta-analysis

“…Thus, while hypertension is the strongest risk factor for deep ICH, a substantial proportion of lobar ICH is due to CAA. CAA has a high recurrence risk (7.4% per year) in a pooled analysis of cohort studies63 so has caused the strongest concerns regarding statin use. Observational and randomised data suggest that recurrent ICH can be reduced by antihypertensive therapy64; however, CAA currently lacks any specific preventative therapy.…”

Finger-Like Projections in Lobar Haemorrhage on Early Magnetic Resonance Imaging Is Associated with Probable Cerebral Amyloid Angiopathy

“…Identification of cerebral amyloid angiopathy (CAA)-related intracerebral haemorrhage is important because of the associated risk of death, worse functional outcome, haemorrhage recurrence, and post-stroke dementia [1][2][3][4]. The magnetic resonance imaging (MRI)-based modified Boston criteria have excellent sensitivity and good specificity for CAA [5].…”