Microbleeds on gradient-echo T2*-weighted MR images from patients with multiple simultaneous intracerebral haemorrhages

Background. Multiple simultaneous intracerebral haemorrhages (ICH) occur rarely and the mechanism remains unknown. In this report, we compare several clinical factors of multiple haemorrhages, including microbleeds, with single intracerebral haemorrhages and discuss a potential explanation for their occurrence. Methods. One hundred and ninety consecutive patients with intracerebral haemorrhage who were admitted within 24 hours after onset from January 2003 to November 2005 were included in the study. Several clinical factors, including the number of microbleeds on gradient-echo T2*-weighted magnetic resonance images, were compared between patients with single and multiple haemorrhages. Findings. Computed tomography scans revealed that nine patients had multiple intracerebral haemorrhages. In all cases, five or more microbleeds were revealed on T2*-weighted magnetic resonance images. This was significantly higher than the number of microbleeds in patients with single intracerebral haemorrhage (p < 0.05). Systolic blood pressure on admission was >= 200 mmHg in seven of the nine patients and was higher than in patients with a single haemorrhage (p = 0.05). Conclusions. Elevated blood pressure induced by an initial haemorrhage was speculated to be the result of secondary haemorrhages in some patients with multiple microbleeds. Thus, strict blood pressure control may help to prevent the occurrence of multiple haemorrhages.