Small Chronic Hemorrhages and Ischemic Lesions in Association With Spontaneous Intracerebral Hematomas

Abstract

Background and Purpose-It has been speculated that the same type of hypertensive small-artery disease can cause either intracerebral hemorrhages or ischemic lesions, depending on the circumstances. Methods-To test this hypothesis, we examined the association between spontaneous intracerebral hematomas and both small chronic hemorrhages and ischemic lesions using echo planar and T2-weighted MRI. We considered a hypointense area to represent a hemorrhage and a hyperintense area to represent an ischemic lesion. Results-We identified small hypointense lesions in 56.7% of 30 patients with intracerebral hematomas (mean age, 62.2 years; total number of lesions, 108) and in 25.4% of 59 patients without hematomas (mean age, 67.6 years; total lesions, 28). The incidence of hypertension was 88.3% in patients with intracerebral hematomas and 42.3% in those without. The hypointense lesions were found in 56.0% of 50 patients with hypertension, whereas they were found only in 10.3% of 39 patients without hypertension. The hypointense lesions were most common in the subcortex, followed by the putamen, pons, thalamus, and cerebellum. The hyperintense lesions were of a higher grade in patients with intracerebral hematomas than in those without. The hypointense lesions were commonly surrounded by hyperintense areas. Additionally, in 3 of 3 autopsied brains, we found hemosiderin deposits around arteriosclerotic microvessels and a surrounding small infarction in areas that had appeared as small hypointense lesions surrounded by hyperintensity on MRI. One specimen also had an organized miliary pseudoaneurysm. Conclusions-Our findings indicate that spontaneous intracerebral hematomas are frequently associated with small chronic hemorrhages, ischemic lesions, and hypertension. We speculate that hypertensive intracerebral hemorrhage may have the same microangiopathic basis as cerebral infarction. (Stroke. 1999;30:1637-1642.)

Cerebral Microbleeds in Patients With Intracerebral Hemorrhage Are Associated With Previous Cerebrovascular Diseases and White Matter Hyperintensity, but Not With Regular Use of Antiplatelet Agents

“…5,29) Cerebral microbleeds are also associated with the presence of areas of white matter hyperintensity on T 2 -weighted MR imaging, although the cause is not clear. Cerebral microbleeds are thought to be associated with the progression of small artery disease manifesting as bleeding and symptomatic intracerebral hemorrhage (ICH).…”

“…2,17) The presence of cerebral microbleeds appears to be linked to age, sex, history of cerebrovascular diseases, hypertension, diabetes mellitus, and use of antithrombotics. 1,5,11,16,17,24,29) The deep perforating arteries feeding the areas of the brain harboring cerebral microbleeds show moderate to severe lipohyalinosis, and occasional amyloid deposits or ruptured arteriosclerotic microvessels. 5,29) Therefore, the association of cerebral microbleeds with ischemic vascular diseases is unsurprising, although usually considered as a risk factor for future ICH.…”

Relationship Between Stroke and Asymptomatic Minute Hemorrhages in Hypertensive Patients.

“…Second, minute hemorrhages might result from hemorrhagic transformation of asymptomatic cerebral infarction, because symptomatic hemorrhage often co-exists with asymptomatic cerebral infarction 12,20,26) and cerebral infarction tends to show hemorrhagic transformation in the presence of hypertension. 16) In our patients, symptomatic cerebral infarction was always associated with asymptomatic cerebral infarction 12) and the infarction group had hypertension as well.…”

In vivo iron quantification in collagenase‐induced microbleeds in rat brain

“…BMB are visible in gradient recalled echo T 2 * magnetic resonance (MR) imaging as focal regions of signal loss (22,23) and have been histopathologically related to hemosiderin (7,24,25), the (paramagnetic) iron-protein complex associated with pathologic iron storage following hemorrhage (26) and ferritin breakdown (27). Thus, BMB represents a source of pathologic iron in the brain that is potentially cytotoxic (e.g., free radical production through the Fenton reaction).…”

“…A few studies have compared radiologic BMB with postmortem human tissue and have noted evidence of associated tissue damage (7,24,25). However, in vivo animal studies would allow the investigation of temporal relationships regarding tissue damage evolution following BMB and possible interventions.…”