Initial microbleeds at MR imaging can predict recurrent intracerebral hemorrhage

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Abstract
Background Intracerebral microbleeds (MBs) are frequently observed in intracerebral hemorrhage (ICH) patients. Although MBs have been shown to be pathogenetically related with ICH, it is not known whether MBs are predictors of recurrent ICHs. Methods Among 220 acute symptomatic primary ICH patients, 112 patients who underwent gradient-echo T2*-weighted MR imaging (GRE) within 10 days after symptom onset were considered for this study. Among them, the final 63 patients who consented to follow-up clinical, laboratory and GRE studies were included. The presence and number of ICHs (mean diameter >5 mm) and MBs on baseline and follow-up GRE were evaluated. The relationship of recurrent ICHs with initial and follow-up clinical and laboratory data as well as the MBs was assessed. Results Among 63 patients, 43 (68.3%) had MBs (median, 2; range, 1 to 17) on baseline GRE. Seven (11.1%) patients (6 with initial MBs; 1 without initial MBs) developed recurrent ICHs, and 19 (30.2%) had new MBs during a median 23.3 months (range, 8.3 to 33.0) of follow-up. The number of initial MBs on baseline GRE was significantly (p < 0.0001) associated with development of recurrent ICHs whereas other clinical and laboratory data were not. Conclusions Recurrent ICHs and MBs are common after long-term follow-up of primary ICH. The number of MBs on baseline GRE may predict the recurrence of the ICH.