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