Abstract 81: Rapid Microbleed Formation in the First Year Following Primary Intracerebral Hemorrhage

Introduction: Cerebral microbleeds (MBs) have emerged as a marker for a hemorrhage-prone vasculopathy. Few studies have evaluated MBs prospectively following intracerebral hemorrhage (ICH). We sought to investigate the frequency of rapid MB development in a predominantly African-American hypertensive ICH population. Methods: The Differences in the Imaging of Primary Hemorrhage Based on Ethnicity or Race (DECIPHER) study is an ongoing prospective, longitudinal, MR-based cohort study designed to evaluate racial/ethnic differences in risk factors for MBs and to prospectively evaluate the prognostic impact of MBs in underserved patients with ICH. We evaluated new MB formation in 2 time periods: from baseline to 30-day and from 30-day to 1-year. All 30-day images were coregistered to the baseline images in the first analysis; 1-year images were coregistered to 30-day images in the second. MB presence and location were determined by consensus review. Only subjects with 3T GRE sequences were included in this analysis. Univariate analyses were performed for both time intervals and subsequent logistic regression analysis was performed on the 30-day to 1-year analysis with new MB formation as the outcome variable. Results: Of the 35 subjects in the baseline to 30-day analysis, 7 (20%) had new MBs, compared to 20 of 55 (36%) in the 30-day to 1-year analysis. Univariate analyses are shown in the Table. Primary ICH location was deep in 32/35 (91%) in the first analysis and in 35/47 (74%) in the second. ApoE status, CAD, smoking status, and atrial fibrillation were not significantly different in either analysis. Logistic regression analysis demonstrated that MAP was significantly associated with new MB formation (OR 1.04 [95% CI 1.0, 1.07], p=0.038); a protective effect of hyperlipidemia was non-significant (OR 0.256, p=0.116). Conclusions: Despite a relatively small sample size, we found that more than one-third of ICH patients surviving one year developed new MBs, which suggests a dynamic and rapidly progressive vasculopathy at work. Future studies will examine the impact of new MB formation on patient outcomes.