Ahead of Print: Cerebral Microbleeds in Patients with Acute Subarachnoid Hemorrhage

Background: Cerebral microbleeds (CMBs) are commonly found after stroke, but have not been previously studied in patients with subarachnoid hemorrhage (SAH).

Objective: To study the prevalence, radiographic patterns, predictors, and impact on outcome of CMBs in patients with SAH.

Methods: We analyzed retrospectively 39 consecutive patients who underwent T2*-weighted gradient-echo imaging within seven days after onset of spontaneous SAH. We report frequency and location of CMBs and show their association with demographics, vascular risk factors, the Hunt-Hess grade, the modified Fisher Scale, the Acute Physiologic and Chronic Health Evaluation II, MRI findings including diffusion-weighted imaging lesions (DWILs), and laboratory data, as well as data on rebleeding, global cerebral edema, delayed cerebral ischemia, seizures, the Telephone Interview for Cognitive Status, and the modified Rankin Scale.

Results: Eighteen (46%) patients had CMBs. Of these patients, nine had multiple CMBs, and overall a total of 50 CMBs were identified. The most common locations of CMBs were lobar (n=23), followed by deep (n=15) and infratentorial (n=12). After adjustment for age and history of hypertension, CMBs were related to the presence of DWILs (OR, 5.24; 95% CI, 1.14 to 24.00; p = 0.033). Three months after SAH, patients with CMBs had non-significantly higher modified Rankin Scale scores (OR, 2.50; 95% CI, 0.67 to 9.39; p = 0.175).

Conclusion: This study suggests that CMBs are commonly observed and associated with DWILs in patients with SAH. Our findings may represent a new mechanism of tissue injury in SAH. Further studies are needed to investigate CMBs’ clinical implications.

From: Cerebral Microbleeds in Patients with Acute Subarachnoid Hemorrhage by Jeon et al.

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