[Analysis of coexisting and associated factors of intracerebral hemorrhage lesions in patients with recent subcortical small infarct].

Abstract

Objective: To explore the clinical characteristics and related risk factors of intracerebral hemorrhage (ICH) lesions identified on susceptibility-weighted imaging (SWI) sequences in patients with recent subcortical small infarct (RSSI). Methods: The patients with lenticulostriate artery territory RSSI admitted to the Department of Neurology, the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2022 was retrospectively collected. Demographic information, past medical history, laboratory, and imaging data were collected. Observe the ICH lesions in patients on the brain SWI sequence and divide RSSI patients into the coexisting-ICH group (n=37) and the non-ICH group (n=324) according to whether they have ICH. At the same time, the hemorrhage-related imaging features coexisting such as cerebral microbleeds (CMBs), cerebral surface siderosis (cSS), and probable cerebral amyloid angiopathy (CAA). Multifactorial logistic regression model was used to analyze the associated factors of ICH lesions in RSSI patients. Results: A total of 361 patients with RSSI in the lenticulostriate artery territory area were included. The mean age was (60±12) years, with 243 male patients (67.3%). Among them, 37 patients (10.2%) had coexisting ICH lesions, mainly presenting as strict deep type [29 cases (78.4%)], with others including strict lobar type [2 cases (5.4%)], infratentorial type [2 cases (5.4%)], and mixed type[ 4 cases (10.8%)]. 30 cases (8.3%) had concomitant strict lobar CMBs, 5 cases (1.4%) had cSS, and 23 cases (6.4%) met the Boston 2.0 criteria for probable CAA. Multivariate logistic regression model analysis revealed that the high-grade enlargement of perivascular spaces in the basal ganglia (HEPVS) (OR=3.356,95%CI:1.208-9.320,P=0.020) were associated with the presence of ICH lesions. When the total cerebral small vessel disease (CSVD) burden score was used to represent other CSVD imaging markers for analysis, the CSVD total burden score (OR=2.319,95%CI:1.596-3.372,P<0.001) was also found to be associated with the presence of ICH lesions. Conclusions: Among patients with RSSI, 10.2% have ICH lesions visible on SWI, primarily manifesting as non-strict lobar types. The total burden of CSVD, particularly the HEPVS in the basal ganglia region, is associated with coexisting ICH.