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From the Department of Neurology (B.R.C., A.W.H., R.F.B., C.S.K.), Georgetown University, Washington, DC; Washington Hospital Center (A.W.H., J.T.F., C.S.K.), Washington, DC; Suburban Hospital Stroke Program (J.G.M.), Bethesda, MD; and National Institute of Neurological Disorders and Stroke (L.D., S.W.), National Institutes of Health, Bethesda, MD.
Address correspondence and reprint requests to Dr. Chelsea S. Kidwell, Washington Hospital Center Stroke Center, 110 Irving Street N.W., East Building Room 6126, Washington, DC 20010 ck256{at}georgetown.edu
Background: Primary intracerebral hemorrhage is two to three times more common in many racial populations, including black patients. Previous studies have shown that microbleeds, identified on gradient echo MRI (GRE), are present in 50–80% of patients with primary ICH. The objective of this study was to compare, by race, the rates, risk factors, and topography of microbleeds in patients hospitalized for primary ICH.
Methods: Patients diagnosed with primary ICH at two metropolitan stroke centers were included. Clinical and neuroimaging data were recorded for each patient. Analyses were performed to compare baseline characteristics as well as imaging findings by race.
Results: A total of 87 patients met inclusion criteria (42 black subjects, 45 white subjects). The black cohort was younger (p < 0.001), and had a greater rate of hypertension (p = 0.001), but not other vascular risk factors. Microbleeds were more prevalent in the black population, with 74% of blacks having one or more microbleeds compared to 42% of whites (p = 0.005). The black population also tended to have a greater frequency of microbleeds in multiple territories than the white population (38% vs 22%, p = 0.106). When adjusting for age, hypertension, and alcohol use, race was an independent predictor of microbleeds (OR 3.308, 95% CI 1.144–9.571, p = 0.027).
Conclusions: These pilot data suggest that significant racial differences exist in the frequency and topography of microbleeds in patients with primary ICH. Microbleeds may be an important emerging imaging biomarker with the potential to provide insights into ICH pathophysiology, prognosis, and disease progression, as well as possible therapeutic strategies, particularly in medically underserved populations.
Abbreviations: CAA = cerebral amyloid angiopathy; FLAIR = fluid-attenuated inversion recovery; FOV = field of view; GRE = gradient echo imaging; SES = socioeconomic status; TE = echo time; TR = repetition time.
Supported by the Division of Intramural Research of the National Institute of Neurological Disorders and Stroke (NINDS), NIH. C.S.K. receives funding from the NINDS, grants U54NS057405 and P50 NS44378.
Disclosure: The authors report no disclosures.
Disclaimer: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke, the National Institutes of Health, or the other sponsors.
Received January 23, 2008. Accepted in final form July 3, 2008.
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