Prevalence and Predictors of Ischemic Lesions in Spontaneous Intracerebral Hemorrhage in a Multiethnic Population: an Observational Study

Abstract Background Intracerebral hemorrhage (ICH), the second most prevalent stroke type has significant morbidity and mortality, and great functional dependence. Although concomitant ischemic lesions are documented, their prevalence and predictors among ethnic groups are undefined and studies focused on the Brazilian population are currently lacking. Objectives The primary objective was to assess the prevalence, predictors, and clinical outcome associations of early post-ICH (≤ 15 days) ischemic lesions on MRI. Secondary objectives evaluated their correlations with clinical/epidemiological characteristics, cerebral amyloid angiopathy (CAA), microbleeds, and SMASH-U-defined ICH etiologies. Methods This observational, cross-sectional study analyzed database, imaging, and medical records from consecutive ICH patients admitted to a tertiary hospital from 2009 to 2018. Data were analyzed using multivariable logistic regression to generate a predictive model. Results In a cohort of 89 patients (mean age 61.3 ± 16.6 years; 52.8% female), the prevalence of ischemic lesions was 27% (n = 24). The most common etiologies were hypertension (39.8%) and CAA (29.5%). Independent predictors of ischemic lesions included CAA (OR = 12.8, 95%CI 2.55–91.6, p = 0.004), admission ICH volume (OR = 0.98, 95%CI 0.95-1.0, p = 0.047), maximum SBP within 48h (OR = 1.04, 95%CI 1.01–1.07, p = 0.015), intraventricular hemorrhage (OR = 19.5, 95%CI 3.97–136, p < 0.001), and cortical superficial siderosis (CSS) (OR = 15.8, 95%CI 2.0-194, p = 0.015). Predictors of poor functional outcome were antiplatelet therapy (OR = 7.24, 95%CI 1.57–41.5, p = 0.015), admission ICH volume (OR = 1.04, 95%CI 1.02–1.07 p = 0.002), and hematoma expansion (OR = 6.06, 95%CI 1.16–37.2, p = 0.037). Ischemia did not predict functional outcome or mortality, though it was associated with longer hospital and ICU stays. The sole predictor of mortality was GCS score (OR = 0.65, 95%CI 1.1–3.03, p = 0.038). Conclusions MRI-detected ischemic lesions were frequent in ICH patients. Independent predictors included CAA, admission ICH volume, maximum SBP within 48h, intraventricular hemorrhage and CSS. No association was found between these lesions and clinical outcomes or mortality. Further research is essential to elucidate the role and pathogenesis of microvascular disease guiding therapeutic strategies.