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Neuroradiology

, Volume 36, Issue 7, pp 504–508 | Cite as

Significance of haemorrhagic lacunes on MRI in patients with hypertensive cerebrovascular disease and intracerebral haemorrhage

  • J. Scharf
  • E. Bräuherr
  • M. Forsting
  • K. Sartor
Diagnostic Neuroradiology

Abstract

Our purpose was to determine the frequency and signifcance of haemorrhagic lacunes (HL) on MRI in patients with a history of, or at risk for intracerebral haemorrhage. We examined 72 patients with old spontaneous intracerebral haemorrhage (ICH) using T1-and T2-weighted spin-echo sequences. MRI studies of 137 consecutive patients with cerebrovascular disease but no known ICH were also reviewed. Both groups showed about the same degree of age-related white matter change and nonhaemorrhagic lacunar infarcts, whereas the ICH group had a higher frequency of HL (12/72 patients) than the non-ICH group (6/131 patients,p<0.01). These results correlate well with reported pathological findings. We conclude that haemorrhagic lacunes found on MRI studies of patients with cerebrovascular disease may suggest a higher risk of intracerebral haemorrhage.

Key words

MRI Intracerebral haemorrhage Hypertensive cerebrovascular disease 

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References

  1. 1.
    Fisher CM (1971) Pathological observations in hypertensive cerebral hemorrhage. J Neuropathol Exp Neurol 30: 536–550Google Scholar
  2. 2.
    Fisher CM (1965) Lacunes: small, deep cerebral infarcts. Neurology 15: 774–784Google Scholar
  3. 3.
    Zeumer H, Schonsky B, Sturm KW (1980) Predominant white matter involvement in subcortical arteriosclerotic encephalopathy (Binswanger disease). J Comput Ass Tomogr 4: 14–19Google Scholar
  4. 4.
    Ringelstein EB, Zeumer H, Schneider R (1985) Der Beitrag der zerebralen Computertomographie zur Differentialtypologie und Differentialtherapie des ischämischen Großhirninfarktes. Fortschr Neurol Psychiat 53: 315–336Google Scholar
  5. 5.
    Millikan C, Futrell N (1990) The fallacy of the lacune hypothesis. Stroke 20: 1251–1257Google Scholar
  6. 6.
    Bamford JM, Warlow CP (1988) Evolution and testing of the lacunar hypothesis. Stroke 19: 1074–1082Google Scholar
  7. 7.
    Landau WM (1989) Au clair de lacune: Holy, wholly, holey logic. Neurology 39: 725–730Google Scholar
  8. 8.
    Rothrock JF, Lyden PD, Hesselink JR, Brown JJ, Healy ME (1987) Brain magnetic resonance imaging in the evaluation of lacunar stroke. Stroke 18: 781–786Google Scholar
  9. 9.
    Kertesz A, Black SE, Nicholson L, Carr T (1987) The sensitivity and specificity of MRI in stroke. Neurology 37: 1580–1585Google Scholar
  10. 10.
    Gomori JM, Grossman RI, Steiner I (1988) High-field magnetic resonance imaging of intracranial hematomas. Isr J Med Sci 24: 218–223Google Scholar
  11. 11.
    Sipponen JT, Sepponen RE, Sivula A (1983) Nuclear magnetic resonance (NMR) imaging of intracerebral hemorrhage in the acute and resolving phases. J Compt Ass Tomogr 7: 954–959Google Scholar
  12. 12.
    Gomori JM, Grossman RI, Goldberg HI, Zimmerman RA, Bilaniuk LT (1985) Intracranial hematomas: imaging by highfield MR. Radiology 157: 87–93Google Scholar
  13. 13.
    Atlas SW, Grossman RI, Gomori JM, Hackney DB, Goldberg HI, Zimmerman RA, Bilaniuk LT (1987) Hemorrhagic intracranial malignant neoplasms: spin-echo MR imaging. Radiology 164: 71–77Google Scholar
  14. 14.
    Winkler ML, Olsen WL, Mills TC, Kaufman L (1987) Hemorrhagic and nonhemorrhagic brain lesions: evaluation with 0.35 T fast MR imaging. Radiology 165: 203–207Google Scholar
  15. 15.
    Hackney DB, Atlas SW, Grossman RI, Gomori JM, Goldberg HI, Zimmerman RA, Bilaniuk LT (1987) Subacute intracranial hemorrhage: contribution of spin density to appearance on spin-echo MR images. Radiology 165: 199–202Google Scholar
  16. 16.
    DeLaPaz RL, New PF, Buonanno FS, Kistler JP, Oot RF, Rosen BR, Taveras JM, Brady TJ (1984) NMR imaging of intracranial hemorrhage. J Compt Ass Tomogr 8: 599–607Google Scholar
  17. 17.
    Sipponen JT, Sepponen RE, Tanttu JI, Sivula A (1985) Intracranial hematomas studied by MR imaging at 0.17 and 0.02 T. J Compt Ass Tomogr 9: 698–704Google Scholar
  18. 18.
    Challa VR, Moody DM (1989) The value of magnetic resonance imaging in the detection of type II hemorrhagic lacunes. Stroke 20: 822–825Google Scholar
  19. 19.
    Awad IA, Spetzler RF, Hodak JA, Awad CA, Carey R (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke 17: 1084–1089Google Scholar
  20. 20.
    DeWitt LD (1985) Clinical use of nuclear magnetic resonance imaging in stroke. Stroke 17: 328–331Google Scholar
  21. 21.
    Awad I, Modic M, Little JR, Furlan AJ, Weinstein M (1986) Focal parenchymal lesions in transient ischemic attacks: correlation of computer tomography and magnetic resonance imaging. Stroke 17: 399–403Google Scholar
  22. 22.
    Gomori JM, Grossman RI (1988) Mechanisms responsible for the MR appearance and evolution of intracranial hemorrhage. Radio Graphics 8: 427–440Google Scholar
  23. 23.
    Thulborn KR, Sorensen AG, Kowall NW, McKee A, Lai A, McKinstry RC, Moore J, Rosen BR, Brady TJ (1990) The role of ferritin and hemosiderin in the MR appearance of hemorrhage: a histopathologic biochemical study in rats. AJNR 11: 219–297Google Scholar
  24. 24.
    Stehbens WE (1972) Intracerebral and intraventricular hemorhage. In: Pathology of the cerebral blood vessels. Mosby, St. Louis, pp 284–318Google Scholar
  25. 25.
    Poirier J, Gray F, Gherardi R, Derouesne C (1985) Cerebral lacunae: a new neuropathological classification. (abstract). Neuropathol Exp Neurol 44: 312Google Scholar
  26. 26.
    Gomori JM, et al. (1986) Occult cerebrovascular malformations: high field MRI. Radiology 158: 707–713Google Scholar
  27. 27.
    Drayer B, et al. (1986) MRI of brain iron. AJNR 7: 337–380Google Scholar
  28. 28.
    Yates PO (1976) The central nervous system in hypertensive vascular disease. In: Blackwood W, Corsellis JAN (eds) Greenfield's Neuropathology 3rd edn., pp 125–140Google Scholar
  29. 29.
    Bogousslavasky J, Van Melle G, Regli F (1988) The Lausanne Stroke Registry: analysis of 10,000 consecutive patients with first stroke. Stroke 19: 1083–1092Google Scholar
  30. 30.
    Mutlu N, Berry RG, Alpers BJ (1963) Massive cerebral hemorrhage. Arch Neurol 8: 644–661Google Scholar
  31. 31.
    McCormick WF, Rosenfield DB (1973) Massive brain hemorrhage: a review of 144 cases and an examination of their causes. Stroke 4: 946–954Google Scholar
  32. 32.
    Hungerbühler JP, Regli F, Van Melle G, Bogousslavsky J (1983) Spontaneous intracerebral haemorrhages (SICHs): clinical and CT features; immediate evaluation of prognosis. Arch Suisses Neurol Neuroch Psych 132: 13–27Google Scholar
  33. 33.
    Brott T, Thalinger K, Herzberg V (1986) Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 6: 1078–1083Google Scholar
  34. 34.
    Awad IA, Johnson PC, Spetzler RF, Hodak JA (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations. Stroke 17: 1090–1097Google Scholar
  35. 35.
    Braffman BHZ, Zimmerman RA, Trojanowski JQ, Gonatas NK, Hickey WF, Schlaepfer WW (1988) Brain MR: pathologic correlation with gross and histopathology. 2. Hyperintense white-matter foci in the elderly. AJNR 9: 629–636Google Scholar
  36. 36.
    Inzitari D, Giordano GP, Ancona AL, Pracucci G, Mascalchi M, Amaducci L (1990) Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension. Stroke 21: 1419–1423Google Scholar
  37. 37.
    Hijdra A, Verbeeten B, Verhulst J (1990) Relation of leukoaraiosis to lesion type in stroke patients. Stroke 21: 890–894Google Scholar
  38. 38.
    Russel RWR (1984) Pathological changes in small cerebral arteries causing occlusion and haemorrhage. J Cardiovasc Pharmacol 6: 691–695Google Scholar
  39. 39.
    Cross PA, Atlas SW, Grossman RI (1990) MR evaluation of brain iron in children with cerebral infarction. AJNR 11: 341–348Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • J. Scharf
    • 1
  • E. Bräuherr
    • 1
  • M. Forsting
    • 1
  • K. Sartor
    • 1
  1. 1.Department of NeuroradiologyUniversity of Heidelberg Medical SchoolHeidelbergGermany

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