Original Article
Nascent Deep Microbleeds and Stroke Recurrences

https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.035Get rights and content

Background

Cerebral microbleeds (MBs) on gradient echo T2-weighted magnetic resonance imaging (MRI) scans are associated with the severity of cerebral microangiopathies. This study investigated the contributions of nascent deep MBs to stroke recurrence.

Methods

We prospectively analyzed nascent deep MBs in patients admitted to our hospital who were treated for index strokes between April 2004 and November 2009. The number of nascent deep MBs was counted on T2-weighted MRI scans around 1 year after the index strokes, and compared to previous MRIs on admission. Stroke recurrence–free rate curves were generated using the Kaplan–Meier method using the log-rank test. The odds ratio for nascent deep MBs was derived using a multivariate logistic regression model that was based on recurrent strokes and other risk factors.

Results

We evaluated the MRIs (interval between MRIs 14.6 ± 5.9 months) of 508 patients (207 women; 68.9 ± 11.5 years), with a follow-up period of 44.1 ± 15.4 months. Repeated T2*-weighted MRI scans revealed 256 nascent deep MBs in 116 of 508 patients. The incidence of deep intracerebral hemorrhage was significantly greater in patients with nascent deep MBs than those without (2.0% vs 0.4% per year, respectively; P < .0001). Multivariate analyses revealed that the rate of nascent deep MBs was significantly elevated in patients whose stroke recurrences took the form of deep intracerebral hemorrhages (odds ratio 5.41; P = .007), when adjusted for hypertension, preexisting MBs, and other risk factors.

Conclusions

Our findings suggested that nascent deep MBs might be associated with stroke recurrence, in particular with deep intracerebral hemorrhage.

Section snippets

Subjects

Between April 2004 and October 2009, we enrolled patients who were consecutively admitted to our hospital within 7 days of experiencing a stroke (index stroke). Follow-up took place until January 2010 at the latest, and stroke recurrences were evaluated in all patients. For patients with long follow-up periods, repeat MRI scans were performed around 1 year after the index strokes and were compared to the initial MRI scan obtained at admission to identify any nascent MBs and any asymptomatic

Results

Of the 1095 patients consecutively enrolled during the study period, we obtained repeated T2-weighted MRI scans from 508 patients (207 women, 68.9 ± 11.5 years of age) with a modified Rankin Scale score ≤ 3. The mean follow-up period was 44.1 ± 15.4 months. The types and frequencies of index strokes at admission were as follows: ICHs in 114 patients (28 lobar and 86 deep ICHs), lacunar infarctions in 149, atherothrombotic infarctions in 125, cardioembolic infarctions in 65, infarctions of

Discussion

We hypothesized that nascent MBs might be directly associated with the current degree of cerebral microangiopathy. We prospectively examined nascent deep MBs as a potential clinical risk factor in patients with strokes.

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