Anatomical distribution of cerebral microbleeds and intracerebral hemorrhage in vertebrobasilar dolichoectasia

Abstract

ObjectivesVertebrobasilar dolichoectasia (VBD) is a dilatative arteriopathy associated with intracerebral hemorrhage. In the present study, we sought to evaluate the frequency and anatomical distribution of cerebral microbleeds (cMBs) and intracerebral hemorrhage (ICH) in VBD.MethodsFrom a MRI database 94 VBD patients were identified and analyzed with special emphasis on cMBs and ICH on T2*-weighted gradient echo images (GRE) in relation to the established diagnostic MRI criteria of VBD (diameter, height, and lateral position). cMBs/ICH location was categorized into anterior/posterior circulation. Clinical information like demographic details, clinical symptoms, and comorbidities were abstracted from the case records. An extensive modelling approach using generalized linear mixed-effects models was used.ResultsOverall, 79 (84.0%) patients (mean age 72.1±10.0 years, 74.7% male) with a standard stroke MRI protocol including T2*-weighted images were included in the analysis. cMBs were observed in 38/79 (48.1%) patients, ranging from 1 to 84 cMBs per patient. In the posterior circulation cMBs were observed more frequently (34/38 (89.5%)) in comparison to the anterior circulation (24/38 (63.2%)). cMBs were observed in the thalamus in 20/38 (52.6%), hippocampus in 1/38 (2.6%), occipital lobe in 18/38 (47.4%), pons in 6/38 (15.8%), medulla oblongata in 2/38 (5.2%), and cerebellum in 14/38 (36.8%) patients. ICH was observed in only 6/79 (7.6%) patients. There were significantly more cMBs in the posterior- (NCMBs-PC = 1.717, 95%CI: 1.336–2.208, p = 0.0315) than in the anterior circulation.Logistic regression model showed a significant positive effect of clinical symptoms such as ischemic, TIA and hemorrhagic stroke on the presence of cMBs (OR = 3.34, 95%CI [2.0–5.57], p = 0.0184; ndf = 78, AIC = 107.51).General linear model showed that clinical symptoms have a highly significant effect on the number of cMBs (N = 2.78, 95%CI [2.51–3.07], p<2*10–16; ndf = 78, AIC = 1218).ConclusioncMBs and ICH may be observed in the anterior and posterior circulation in VBD but they occur more frequently in the posterior circulation. Most common anatomical locations of cMBs in VBD were the thalamus, occipital lobe and cerebellum. This posterior dominance of cMBs and ICH in VBD might reflect a specific underlying vascular pathology.

Relationships between intracranial arterial dolichoectasia and small vessel disease in patients with ischaemic stroke: a systematic review and meta-analysis

“…CMBs are small (generally 2–10 mm), round or ovoid hypointensity lesions detected on T2*-gradient echo (GRE)/susceptibility-weighted imaging (SWI) and commonly found in patients with CSVD, including hypertensive arteriopathy (arteriolosclerosis) and cerebral amyloid angiopathy (CAA) [ 41 , 42 ]. Our results confirm the previously reported associations between CMBs and large vessel dilatative arteriopathy, IADE and its subset (VBD), in various populations including ischaemic stroke [ 32 , 33 , 43 ]. The degree of basilar artery tortuosity, BA dolichosis, was independently associated with deep CMBs (Odds ratio (OR) 4.14, P = 0.002) [ 32 ].…”

Brainstem hemorrhage is uncommon and is associated with high morbidity, mortality, and prolonged hospitalization

“…These findings were consistent with prior observations of a higher frequency of pontine and cerebellar hemorrhage relative to other parts of the brainstem. 17 A study looking at cerebral microbleeds and ICH among 79 patients with vertebrobasilar dolichoectasia found that only two of the patients had microbleeds in the medulla oblongata and 6 of them had microbleeds in the pons. 17 All brainstem hemorrhage patients in our cohort were men, with a mean age of 58.5±13.1 years.…”

“…17 A study looking at cerebral microbleeds and ICH among 79 patients with vertebrobasilar dolichoectasia found that only two of the patients had microbleeds in the medulla oblongata and 6 of them had microbleeds in the pons. 17 All brainstem hemorrhage patients in our cohort were men, with a mean age of 58.5±13.1 years. Male gender and older age are considered risk factors for hemorrhagic stroke, including brainstem hemorrhage.…”

Vertebrobasilar dolichoectasia in patients with cerebrovascular ischemic stroke: does it have a role in cerebral microbleeds?

“…Detection of CMBs and their territorial distribution depends on MRI gradient echo time (TE) sequence and according to their count the degree of severity was detected [5,35]. Dilatation and elongation of basilar artery was detected in brain MRA image [19,36].…”