Underlying microangiopathy and functional outcome of simultaneous multiple intracerebral hemorrhage

Abstract

ObjectiveTo identify the predominant type of cerebral small vessel disease (SVD) and outcomes in patients with simultaneous multiple intracerebral hemorrhages (SMICH).MethodsConsecutive patients with intracerebral hemorrhage (ICH) from a single-center prospective cohort were retrospectively reviewed. Presumed etiology was classified according to the SMASH-U criteria. Demographics, clinical and laboratory variables, and neuroimaging data were compared between patients with primary SMICH and those with single ICH. Functional outcomes were assessed using the modified Rankin scale 90 days after ICH.ResultsOf the 598 enrolled patients, 37 (6.2%) met the criteria for SMICH. Risk factors for SMICH included a high burden of deep cerebral microbleeds (CMBs) (odds ratio [OR] 1.06, 95% confidence interval [CI], 1.00–1.12; p = 0.040), white matter hyperintensity scores (OR 1.27, 95% CI 1.04–1.57; p = 0.021), history of ICH (OR 3.38, 95% CI 1.31–8.05; p = 0.008), and low serum magnesium levels (OR 0.01, 95% CI 0.00–0.25; p = 0.007). Based on the SMASH-U classification, 15(40.5%) SMICH were classified as hypertension, whereas 17 (45.9%) as undetermined-etiology. To further explore the potential microangiopathy underlying undetermined-SMICH, these patients with undetermined-etiology were compared to those with cerebral amyloid angiopathy-ICH, and were associated with a higher burden of deep CMBs but less severe centrum semiovale enlarged perivascular spaces. Likewise, compared with hypertension-ICH patients, those with undetermined SMICH were consistently associated with a higher deep CMB counts. Moreover, multivariate analysis revealed that SMICH was independently associated with poor outcomes (OR 2.23, 95%CI 1.03–4.76; p = 0.038).ConclusionOur results suggest that most patients with primary SMICH harbor hypertensive-SVD as principal angiopathy. Patients with SMICH are at a high risk of poor outcomes. (ClinicalTrials.gov Identifier: NCT 04803292).

More severe initial manifestations and worse short-term functional outcome of intracerebral hemorrhage in the plateau than in the plain

“…55 The prognostic effect of hemorrhagic locations is controversial. 47,[56][57][58] In our study, lobar ICH acted as a positive role in shortterm functional outcome, which needs further exploration.…”

Cerebral Microbleeds Associate with Brain Endothelial Cell Activation-Dysfunction and Blood-Brain Barrier Dysfunction-Disruption with an Increased Risk of Hemorrhagic and Ischemic Stroke That Is Capable of Exacerbating Neurodegeneration

“…The presence of CMBs in numbers ≥ 10 suggest that there is a significant degree of microvessel disease with increased SVD presence with loss of microvessel integrity and increased vulnerability to undergo extravasation of microvessel blood luminal contents to undergo diapedesis and/or rhexis (rupture).The subsequent increase in CMBs, may increase the risk for both ischemic and hemorrhagic intracerebral stroke.However, based on the recent literature and current evidence, the presence of CMBs should not be a contraindication to intravenous thrombolysis for the treatment of acute cerebral infarction [101]. Additionally, Chacon-Portillo et al have stated that CMBs should not dictate treatment of acute stroke [102].…”