Correlation between burden and distribution of cerebral microbleeds and stroke recurrence and prognosis in survivors of spontaneous intracerebral hemorrhage

To investigate the relationship between the burden and distribution of cerebral microbleeds (CMBs) and the recurrence of ischemic and cerebral hemorrhage in survivors of spontaneous intracerebral hemorrhage (ICH) and their impact on prognosis from northern China. Patients with first-onset spontaneous ICH between January 1, 2019, and October 31, 2023, were consecutively enrolled from the stroke registry of Xianyang Hospital of Yan’an University. Patients were divided into a CMBs group and a without CMBs group based on magnetic susceptibility-weighted imaging findings. Baseline data were collected at admission, and follow-up assessments were conducted via telephone for a period of 12 months post-discharge by trained researchers blinded to patients’ clinical information. The primary outcomes were recurrent stroke and type of recurrent stroke (ischemic or hemorrhagic), while the secondary outcome was long-term (1-year) functional prognosis. Cox proportional hazards models were used to assess the risk of stroke recurrence based on the burden and distribution of CMBs. Logistic regression analysis was used to determine the independent association between CMBs burden and distribution and poor functional prognosis 1 year after cerebral hemorrhage. Among the 412 patients included, CMBs were detected in 278 cases, of which 80 were severe CMBs (≥10 CMBs) and 34 were lobar CMBs. A total of 57 primary endpoint events occurred during the follow-up period, including 22 (5.3%) with intracerebral haemorrhage, 35 (8.5%) with cerebral infarction, and 100 (24.3%) with secondary endpoint events. Severe CMBs (≥10) were associated with haemorrhagic stroke recurrence (HR = 4.592, 95% CI: 1.943–10.848) and were an independent risk factor for poor one-year prognosis in patients with intracerebral haemorrhage (OR = 2.190, 95% CI: 1.205–3.982). However, the distribution of CMBs did not show this relationship. The burden and distribution of CMBs were also not found to be risk factors for ischaemic stroke recurrence (HR = 1.889, 95% CI: 0.876–4.070). The study shows an association between a higher burden of cerebral microbleeds and recurrent intracerebral hemorrhage in this cohort, suggesting that such patients should be closely monitored for future strokes.