Document Detail

Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage.
MedLine Citation:
PMID:  15073385     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Small asymptomatic cerebral hemorrhages detectable by gradient-echo MRI are common in patients with intracerebral hemorrhage (ICH), particularly lobar ICH related to cerebral amyloid angiopathy (CAA). We sought to determine whether hemorrhages detected at the time of lobar ICH predict the major clinical complications of CAA: recurrent ICH or decline in cognition and function. METHODS: Ninety-four consecutive survivors of primary lobar ICH (age > or =55) with gradient-echo MRI at presentation were followed in a prospective cohort study for 32.9+/-24.0 months. A subset of 34 subjects underwent a second MRI after a stroke-free interval of 15.8+/-6.5 months. Study endpoints were recurrent symptomatic ICH or clinical decline, defined as onset of cognitive impairment, loss of independent functioning, or death. RESULTS: The total number of hemorrhages at baseline predicted risk of future symptomatic ICH (3-year cumulative risks 14%, 17%, 38%, and 51% for subjects with 1, 2, 3 to 5, or > or =6 baseline hemorrhages, P=0.003). Higher numbers of hemorrhages at baseline also predicted increased risk for subsequent cognitive impairment, loss of independence, or death (P=0.002) among subjects not previously demented or dependent. For subjects followed after a second MRI, new microhemorrhages appeared in 17 of 34 and predicted increased risk of subsequent symptomatic ICH (3-year cumulative risks 19%, 42%, and 67% for subjects with 0, 1 to 3, or > or =4 new microhemorrhages, P=0.02), but not subsequent clinical decline. CONCLUSIONS: Hemorrhages identified by MRI predict clinically important events in survivors of lobar ICH. Detection of microhemorrhages may be useful for assessing risk in ICH patients and as a surrogate marker for clinical studies.
Steven M Greenberg; Jessica A Eng; MingMing Ning; Eric E Smith; Jonathan Rosand
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2004-04-08
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  35     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-28     Completed Date:  2004-11-16     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1415-20     Citation Subset:  IM    
Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass 02114, USA.
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MeSH Terms
Cerebral Amyloid Angiopathy / diagnosis*
Cerebral Hemorrhage / diagnosis*,  epidemiology
Magnetic Resonance Angiography*
Middle Aged
Prospective Studies
Grant Support

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