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The following is a summary of “Prevalence and Clinical Implications of Hemosiderin Deposits in Recent Small Subcortical Infarcts,” published in the October 2024 issue of Neurology by Xu et al.  

A quarter of ischemic strokes are classified as lacunar, characterized by recent small subcortical infarcts (RSSIs), yet the long-term outcomes remain poorly understood.  

Researchers conducted a prospective study to characterize hemosiderin deposits (HD) morphology, frequency, and clinical relevance in RSSIs.  

They identified participants with RSSIs and evaluated them using 3T magnetic resonance imaging (MRI), including susceptibility-weighted imaging (SWI), from stroke diagnosis to 12 months. The HDs were categorized in RSSIs on SWI into 4 types (spots, smudge, rim, cluster), and the associations with demographic factors, stroke-related factors, and imaging markers were assessed using adjusted logistic regression.  

The results showed that HDs were observed in 43 (55.0%) of 108 participants within 3 months and 83 (76.9%) 108 within 12 months after stroke onset. The mean time to detect the first HDs was 87 (IQR 53–164) days. A “rim” pattern occurred in at least 26.5% of RSSIs at all follow-up time points, primarily those located in the lentiform/internal capsule (50.0%) or thalamus (36.4%). Infarct volume (OR1.003, 95% CI 1.001–1.006; P=0.004) and the total small vessel disease (SVD) score at baseline (OR 2.50, 95% CI 1.28–4.86; P=0.007) independently predicted HDs at 12 months. The HDs were positively associated with more lacunes (OR 1.60, 95% CI 1.13–2.26; P<0.01) but not with the Fazekas score, number of microbleeds, basal ganglia mineral deposit score, or clinical outcomes.  

They concluded that HDs frequently occur in RSSIs and may be associated with infarct volume and SVD score, highlighting the need to differentiate ischemic RSSIs from primary hemorrhage in subacute and chronic stages.  

Source: neurology.org/doi/10.1212/WNL.0000000000209973