Clinical differences between primary intracerebral hemorrhage with and without microbleeds

Purpose : Patients with primary intracerebral hemorrhage (PICH) frequently demonstrate microbleeds (MB) on gradient-echo T2*-weighted MR images (T2*WI) . We assessed the clinical and radiologic differences between PICH with and without MB. Methods : We studied 174 consecutive patients with PICH who underwent both conventional MRI and T2* WI. Results : MB were observed in 65.5% of patients and ranged in number from 1 to 61. The locations of the MB lesions were most commonly in the cortex/subcortex (39.6%). Age, sex, hypertension, diabetes mellitus, hyperlipidemia, blood pressure on admission, Japan stroke scale on admission and at discharge, and hematoma size of PICH were not significantly correlated with either the MB or non-MB groups. Medication with antithrombotics (antiplatelets and/or anticoagulants), lacunes, and advanced leukoaraiosis (LA) were common in patients with MB. On logistic regression analysis, advanced LA was an independent risk factor associated with the presence of MB in patients with PICH (odds ratio, 2.20; 95% confidence interval, 1.06-3.81). Discussion : MB with PICH were associated MR findings of small artery disease, especially the presence of LA. Patients with MB showed a higher incidence of taking antithrombotics. Lacunar infarction and LA have been suggested to indicate a higher risk of bleeding under antithrombotics. Screening of candidates with MRI findings such as MB, LA and lacunes may be useful when selecting antithrombotic medication for ischemic stroke patients. PICH patients with MB who were associated with small artery disease, in particular the presence of LA with MB, revealed a higher incidence of taking antithrombotics.