Enlarged Perivascular Space in the Basal Ganglia Associated with Coexisting Intracerebral Hemorrhage in Patients with Recent Small Subcortical

Abstract Background : Intracerebral hemorrhage (ICH) is a common vascular disease associated with small blood vessels, and it is not uncommon for individuals with cerebral small vessel disease (CSVD) to develop ICH. Studies have shown that the number and location of cerebral microbleeds (CMBs) are associated with ICH in individuals with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). However, the prevalence of ICH and its related risk factors in individuals with recent subcortical small infarct (RSSI) is still unclear. Methods : This study included 361 patients with complete MRI data. ICH was defined based on the medical history of cerebral hemorrhage and brain MRI and SWI scans, which are sensitive for detecting both old and recent hemorrhages. The location and quantity of enlarged perivascular spaces (EPVS) were assessed using a visual scoring scale. Additionally, evaluation was performed for CMBs,cerebral white matter hyperintensities (HWMHs)and lacunar infarctions(LI). The correlation between ICH and EPVS was analyzed using multivariate logistic regression analysis. Results : The study ultimately included 361 patients with RSSI in the lenticulostriate arterial region, with a mean age of 59.70±12.11 years. Among them, 243 (67.3%) were male, and 34 (9.4%) had concomitant ICH. In univariate analysis, the proportion of patients with a history of cerebral infarction was higher in the ICH group, platelet count was lower, and there were higher proportions of basal ganglia perivascular spaces (BG-HEPVS),CMBs,deep/mixed CMBs,HCMBs (high CMBs),high white matter hyperintensities (HWMHs), and LI. The median CSVD total burden score was also higher in the ICH group.Multivariable logistic regression analysis showed that in Model 1, BG-HEPVS(OR, 4.12; 95% CI, 1.34-12.70; P=0.014) and deep/mixed CMBs (OR, 5.62; 95% CI, 1.50-21.03; P=0.010) were significantly associated with ICH. In Model 2, the total burden of CSVD (OR, 2.26; 95% CI, 1.54-3.33; P<0.001) was significantly associated with ICH. Conclusion : In the population with RSSI, BG-EPVS, deep/mixed CMBs and the total burden of CSVD were significantly associated with ICH. The strength of this association and the ability to identify the risk of bleeding in clinical practice may be useful for the safety of future antithrombotic treatments.