Abstract TP086: High Prevalence of Cerebral Small Vessel Disease Markers and Mixed-location Hemorrhagic Pattern in Brazilian Patients with Spontaneous Intracerebral Hemorrhage

Introduction: Cerebral small vessel diseases (CSVD) are responsible for virtually all spontaneous intracerebral hemorrhages (ICH) and are major contributors to vascular cognitive impairment and stroke-related morbidity and mortality. Most deaths attributed to ICH occur in low-to-middle income countries, where data on the prevalence and phenotypes of CSVD remains limited. We aimed to investigate the prevalence and distribution patterns of CSVD neuroimaging markers in a Brazilian cohort of ICH survivors. Methods: We performed a retrospective analysis of patients with primary ICH admitted to a tertiary Brazilian hospital between 2014 and 2021. CSVD hemorrhagic and non-hemorrhagic imaging markers were graded following the STRIVE-2 criteria. Participants were stratified into strictly lobar, strictly deep and mixed-location hemorrhagic patterns. Several radiological CSVD burden scores were applied, as well as the Boston Criteria version 2.0. Results: A total of 72 subjects were included in the study (age, 60±11.6 years; men, 58%; hematoma volume, 8.3 [IQR 3.9 – 18.5]; hypertension, 77.8%; diabetes mellitus, 23.6%; lobar ICH, 34.7%; deep ICH, 61.1%, cerebellar ICH, 4.2%). The most prevalent CSVD markers were: lacunes, 45 (62.5%); white matter hyperintensities, 49 (68.0%); and cerebral microbleeds, 50 (70.4%). A total of 42 (59.2%) participants presented with mixed-location hemorrhagic markers, whereas 14 (19.7%) with strictly lobar, and 13 (18.3%) with strictly deep hemorrhages. Only 12 (16.9%) participants fulfilled Boston Criteria for probable cerebral amyloid angiopathy (CAA). Among those presenting with lobar ICH (25, 34.7%), 11 (44%) had mixed-location hemorrhages and only 12 (48%) fulfilled Boston criteria for probable CAA. Among those presenting with deep ICH (44, 61.1%), 30 (68.2%) had mixed-location hemorrhages. Higher prevalence and number of lacunes and microbleeds were observed among patients with mixed-location hemorrhages compared to other (strictly lobar and deep) patterns ( p <.05). Conclusions: In this Brazilian cohort, patients with spontaneous ICH exhibited high burden of CSVD markers. Markers traditionally associated with hypertensive arteriopathy (HA) and CAA frequently coexisted, with most patients displaying mixed bleeding patterns. This mixed hemorrhagic phenotype, which is often underestimated in international studies, accounts for a significant part of our population and may represent a severe presentation of CSVD, more closely linked to HA.