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Cerebral Microembolism in Intracerebral Hemorrhage: A Prospective Case–Control Study

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Abstract

Background

Small and remote acute ischemic lesions may occur in up to one-third of patients with spontaneous intracerebral hemorrhage (ICH). Possible mechanisms include cerebral embolism, small vessel disease, blood pressure variability and others. The embolic mechanism has not been adequately studied. Using transcranial Doppler (TCD), we assessed the incidence of spontaneous microembolic signals (MESs) in patients with acute ICH.

Methods

Twenty acute ICH patients were prospectively evaluated within 48 h of hospital admission. Clinical and imaging data were collected. Continuous TCD monitoring was performed in both middle cerebral arteries for a one-hour period on days 1, 3 and 7 of hospital admission. Monitoring was performed in the emergency room, ICU or ward, according to patient location. We compared the frequency and risk factors for MES in patients with ICH and in 20 age- and gender-matched controls without history of ischemic or hemorrhagic stroke.

Results

The mean age was 57.5 ± 14.1 years, and 60% were male. MESs were detected in 7 patients with ICH and in one control patient without ICH (35% vs 5%, p = 0.048). The frequency of MES on day 1 was 15% (3 of 20 patients), on day 3, 26% (5 of 19 patients) and on day 7, 37.5% (3 of 8 patients). Among patients with ICH, those with MES had a tendency to higher frequencies of dyslipidemia (83% vs 33%, p = 0.13) and lobar location of hemorrhages (71% vs 30%, p = 0.15). Two out of 6 patients with ICH who also underwent MRI had remote DWI lesions, of whom one showed MES on TCD.

Conclusion

Micro-embolic signals occur in over one-third of patients with ICH. Further research is needed to identify the sources of cerebral microembolism and their relationship with small acute infarcts in ICH.

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Funding

Dr. Eva Rocha’s visiting scholarship at Massachusetts General Hospital and Harvard Medical School, Boston, was sponsored by the Capes Foundation, Ministry of Education, Brazil (Grant No. 88881.133101/2016-01).

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Authors and Affiliations

  1. Department of Neurology, Universidade Federal de São Paulo, 350 Pedro de Toledo Street, São Paulo, SP, 04039-002, Brazil

    Eva A. Rocha, Felipe Rocha, Izadora Deliberalli, João Brainer C. de Andrade, Irapuá F. Ricarte & Gisele S. Silva

  2. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Eva A. Rocha & Aneesh B. Singhal

  3. Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

    Gisele S. Silva

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  1. Eva A. Rocha
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All authorship requirements have been met, and the final manuscript was approved by all authors

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Correspondence to Eva A. Rocha.

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This study adhered to ethical guidelines, was approved by the Institutional Review Board (IRB), and all patients signed informed consent.

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Rocha, E.A., Rocha, F., Deliberalli, I. et al. Cerebral Microembolism in Intracerebral Hemorrhage: A Prospective Case–Control Study. Neurocrit Care 34, 547–556 (2021). https://doi.org/10.1007/s12028-020-01073-4

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