Russell Mitesh Cerejo, MD

Pasquini M, Benedictus MR, Boulouis G, Rossi C, Dequatre-Ponchelle N, Cordonnier C. Incident Cerebral Microbleeds in a Cohort of Intracerebral Hemorrhage. Stroke. 2016

The authors studied prognostic factors of incident cerebral microbleeds (CMBs) in the PITCH study primary intracerebral hemorrhage (ICH) cohort with at least 2 MRIs and survival for 6 months post event, stratifying the findings according to the index ICH location. 

Amongst 168 included patients (median age 64 years) with ICH, 53% had at least 1 CMB. 

Anatomical distribution and number of CMBs were similar in patients with lobar and non-lobar ICH. Incident CMBs appeared in 80 patients (48%) in a median delay of 3.4 years (including 29 patients without CMBs at ICH onset), with a total number of 285 new CMBs, leading to an incidence rate of 14.2 per 100 person-years. Patients with CMBs at ICH onset had an almost 2.5 fold increased risk of developing incident CMBs during the follow-up period compared with patients without CMBs at ICH onset (aOR 2.27; 95% CI 1.18-4.35). In non-lobar ICH, incident CMBs were associated with incident lacunes (aOR 2.86; 95%CI 1.04-7.85) and with the use of antiplatelet agents during follow-up (aOR 2.89; 95%CI 1.14-7.32), while in lobar ICH incident CMBs were associated with incident radiological macro-hemorrhages (aOR 9.76; 95%CI 1.07-88.77). However, the proportion of antiplatelet agents use was similar in lobar and non-lobar ICH (31% and 32% respectively; p=0.89). 

This study provides long term MRI data and a better understanding into the possible etiologies of primary ICH as related to CMBs, which may be interesting surrogate markers.