Acute ischaemic brain lesions in intracerebral haemorrhage: multicentre cross-sectional magnetic resonance imaging study

We identified all cases with spontaneous lobar intracerebral haemorrhage and appropriate MRI data available

Simone M. Gregoire; Andreas Charidimou; Naveen Gadapa; Eamon Dolan; Nagui Antoun; Andre Peeters; Yves Vandermeeren; Patrice Laloux; Jean-Claude Baron; Hans R. Jäger; David J. Werring


Scholarcy highlights

  • Intracerebral haemorrhage is the most disabling form of stroke, for which acute treatments are limited and there is an urgent need to better understand the pathophysiology to help enhance the development of new treatments
  • The final cohort consisted of 114 patients with intracerebral haemorrhage, 39 of whom fulfilled the criteria for probable cerebral amyloid angiopathy; and 47 age-matched controls
  • Diffusion-weighted imaging lesions were associated with markers of small-vessel damage including total white matter change and the presence of lobar cerebral microbleed, but not with admission blood pressure
  • The distribution and morphology of the detected DWI lesions correlates well with the ‘microinfarcts’ identified in neuropathological studies of patients with CAA. Since these lesions were associated with markers of small-vessel damage severity, rather than conventional risk factors, they probably represent acute small-vessel infarcts related to small-vessel arteriopathy, especially CAA
  • About a third of silent ischaemic lesions were detected within 1 week after intracerebral haemorrhage, and $80% of them within 1 month, which suggests a possible early peak followed by a descending incidence over time, but we were unable to investigate this further as we did not acquire repeat imaging studies in this cohort
  • Adjusting the analysis for variation in magnetic field strength did not substantially weaken the association between strictly lobar microbleeds and the presence of DWI lesions
  • In contrast to our results, they found no association between DWI lesions and white matter change, but this study did not include any intracerebral haemorrhage cases not attributed to CAA, and was not representative of the full spectrum of spontaneous intracerebral haemorrhage. Another recent study found DWI lesions in 23% of patients in a cohort of 118 patients with intracerebral haemorrhage scanned within 1 month, and found that DWI lesions were associated with aggressive blood pressure lowering, but this study did not investigate the relationship of DWI lesions to MRI markers of small-vessel disease and did not use formal criteria to define CAA
  • The presence of Diffusion-weighted imaging lesions may identify a subgroup of patients with intracerebral haemorrhage who might have greater benefit from anti-thrombotic treatment, but clinical studies are needed to address this question

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