Old Microbleeds Are a Potential Risk Factor for Cerebral Bleeding After Ischemic Stroke

  • N. Nighoghossian
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.
  • M. Hermier
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.
  • P. Adeleine
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.
  • K. Blanc-Lasserre
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.
  • L. Derex
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.
  • J. Honnorat
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.
  • F. Philippeau
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.
  • J.F. Dugor
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.
  • J.C. Froment
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.
  • P. Trouillas
    From the Cerebrovascular Disease Center (N.N., M.K.B.-L., L.D., J.H., F.P., P.T.), Department of Radiology (N.N., M.H., J.F.D., J.C.F.), and CREATIS UMR CNRS 5515, and Biostatistical Unit of UCB Lyon I (P.A.), Lyon, France.

書誌事項

タイトル別名
  • A Gradient-Echo T2*-Weighted Brain MRI Study

抄録

<jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Background and Purpose</jats:italic> — </jats:bold> </jats:italic> </jats:bold> T2*-weighted gradient-echo MRI is known to detect old microbleeds (MBs), considered indicative of microangiopathy. MBs might be a potential risk factor for early cerebral bleeding (CB) after ischemic stroke. Therefore, we assessed the impact of MBs on the occurrence of CB after cerebral infarction. </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Methods</jats:italic> — </jats:bold> </jats:italic> </jats:bold> We included prospectively stroke patients who had documented ischemic damage. The imaging protocol involved baseline CT scan, T2*-weighted gradient-echo MRI, diffusion-weighted imaging, T2-weighted imaging, and magnetic resonance angiography and had to be performed within 24 hours after symptom onset. The assessment of CB with T2*-weighted gradient-echo sequence necessitated a focal area of signal loss either within the ischemic area revealed by diffusion-weighted imaging or remote from it. Old MBs were defined on T2*-weighted images as homogeneous rounded areas of signal loss without surrounding edema. CT scan was systematically repeated within the first week to verify CB as diagnosed by the T2* weighted sequence. </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Results</jats:italic> — </jats:bold> </jats:italic> </jats:bold> One hundred patients (mean age, 60±13 years; range, 19 to 83 years; 58 men, 42 women) met the inclusion criteria. MBs were seen in 20 patients on T2*-weighted imaging. Multivariate logistic regression analysis revealed that age, diabetes, previous use of antithrombotic drugs, evidence of an atherothrombotic source of stroke, and lacunar infarct were significantly associated with MBs ( <jats:italic>P</jats:italic> <0.0001). CB was diagnosed in 26 patients: at the acute stage by T2*-gradient echo sequence in 18 patients and with CT scan performed within the first week in 8 patients. Multivariate logistic regression analysis showed that baseline National Institutes of Health Stroke Scale score, diabetes, and MBs were considered significant and independent predictors of CB ( <jats:italic>P</jats:italic> <0.001). </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Conclusions</jats:italic> — </jats:bold> </jats:italic> </jats:bold> Although the pathogenesis of CB after ischemic stroke is multifactorial, the increased observation of CB in patients with MBs suggests that the associated vascular vulnerability contributes to CB. </jats:p>

収録刊行物

  • Stroke

    Stroke 33 (3), 735-742, 2002-03

    Ovid Technologies (Wolters Kluwer Health)

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