Background: Cerebral microbleeds(CMBs) represent microangiopathy in intracerebral hemorrhage(ICH). Their association with BP control-ability in ICH has not been studied.
Objectives: To study influence of CMBs on blood pressure control in acute ICH presenting within 24 hours of symptom onset
Methods: Acute ICH presenting within 24 hours of symptom onset were prospectively enrolled from April ’15 to May ’16 if they fulfilled major inclusion [age>18, GCS >8 (M >4)] and exclusion (Lobar bleed,ICH due to anticoagulants,Pregnancy, Contraindications for MRI) criteria.A baseline brain CT and CT angio was done.Brain MRI(3T) was done within 24 hours of admission to assess CMBs. Blood pressure lowering was carried out as per guidelines with a target SP<140mmHg.The target BP was attempted to be achieved in 24 hours.Based on BP control,patients were divided into two groups: a)Easy(E) and b)Difficult(D) based on control achieved within 7 hours.CMB assessor was blinded to the clinical condition and treatment.
Results: 25 patients were recruited in the study.Mean age was 58.6± 9.69 yrs with 52% females.Median time from symptom onset(TFSO) at presentation was 11.15 hrs(IQR 7.1-17.15).68% patients presented after 12 hours of onset.88% patients were hypertensives most(81.8%) being poorly compliant to treatment.Baseline Mean GCS was12±2.39;Systolic BP(SBP):187.76±21.95;Diastolic BP(DBP):110±13.22. 56% patients had basal gangla hemorrhage, 44% thalamic and 24% had midline shift. 80% had CMBs on SWI-MRI: 90% predominantly deep, 5% infratentorial and 5% lobar.Target BP was achieved in all patients within 24 hours. "E" group had 52% while rest were in "D"group."D" patients were likely to be smokers,had higher mortality at 1 month(p=0.052),had greater number of deep CMBs(p<0.001). Deeper location of CMBs was associated with smoking and higher ICH scores.On multivariate logistic regression, deep CMBs were significantly associated with poor blood pressure control after adjusting for all variables.(p=0.022;AOR:2.134,95%CI:1.117-4.077)
Conclusion: CMBs may impose an influence on blood pressure control in acute spontaneous ICH with a predominant deep location being predictive of difficult to control BP and thereby may require aggressive measures to control BP