Cerebral microbleeds are regionally associated with intracerebral hemorrhage

Background: Cerebral microbleeds (CMB) may be indicative of a hemorrhage-prone microangiopathy. Objective: To determine if increased numbers of these lesions are predictive of intracerebral hemorrhage (ICH), especially in terms of a distributional association. Methods: The authors examined consecutively 227 patients with acute stroke. CMB were counted using T2*-weighted gradient echo MRI data, and old lacunes and leukoaraiosis were also evaluated. The associations between the vascular risk factors and ICH were analyzed. With use of multivariate logistic regression analysis, the locations of the CMB or the old lacunes, which were categorized as being in the corticosubcortical area, the deep gray matter area, or the infratentorial area, were examined with regard to their relationships to the locations of the ICH. Results: The degrees of the CMB (r=0.43, p<0.01) and leukoaraiosis (r=0.20, p<0.01) were well correlated with the presence of ICH. Multivariate analysis revealed that the grades of the CMB were associated with the presence of ICH (p<0.01, odds ratio [OR]=2.67). CMB in the corticosubcortical area (p<0.01, OR=5.50) or deep gray matter (p<0.01, OR=2.55) were strongly associated with the presence of ICH in the same area, but no such association was observed in the case of CMB in the infratentorial area or in the case of old lacunes in any area. Conclusions: Cerebral microbleeds are strongly associated with the presence of intracerebral hemorrhage, and the distributional associations are also quite strong.