Brain Microbleeds Relate to Higher Ambulatory Blood Pressure Levels in First-Ever Lacunar Stroke Patients

Abstract

Background and Purpose— Hypertension is an important risk factor for brain microbleeds (BMBs) in lacunar stroke patients. However, beyond the qualitative label “hypertension,” little is known about the association with ambulatory blood pressure (BP) levels. Methods— In 123 first-ever lacunar stroke patients we performed 24-hour ambulatory BP monitoring after the acute stroke-phase. We counted BMBs on T2*-weighted gradient-echo MR images. Because a different etiology for BMBs according to location has been suggested, we distinguished between BMBs in deep and lobar location. Results— BMBs were seen in 36 (29.3%) patients. After adjusting for age, sex, number of antihypertensive drugs, asymptomatic lacunar infarcts, and white matter lesions, we found 24-hour, day, and night systolic and diastolic BP levels to be significantly associated with the presence and number of BMBs (odds ratios 1.6 to 2.3 per standard deviation increase in BP). Distinguishing between different locations, various BP characteristics were significantly associated with the presence of deep (or combined deep and lobar) BMBs, but not with purely lobar BMBs. Conclusions— Our results underline the role of a high 24-hour BP load as an important risk factor for BMBs. The association of BP levels with deep but not purely lobar BMBs is in line with the idea that different vasculopathies might be involved. Deep BMBs may be a particular marker of BP-related small vessel disease, but longitudinal and larger studies are now warranted to substantiate these findings.

Association between Carotid Artery Plaque Type and Cerebral Microbleeds

“…Our results are concordant with previous research by Staals et al, 33 where 8.9% of patients had only lobar CMBs, 13.8% had only deep CMBs, and 5.7% had combined (both deep and lobar) CMBs. In our population, we did not find any CMBs in the brain stem.…”

“…Symmetric hypointensities in the globi pallidi, likely to represent calcification, and sulcal flow voids from cortical vessels were disregarded. 33 Microbleeds were classified in each cerebral hemisphere (and for infratentorial lesions, these were considered in the right/left cerebellum of right/left side of the brain stem) as absent (grade 1), mild (grade 2; total number of microbleeds, 1-2), moderate (grade 3; total number of microbleeds, 3-10), and severe (grade 4; total number of microbleeds, Ͼ10), according to Lee and colleagues. 34 …”

Ambulatory Blood Pressure in Patients With Lacunar Stroke

“…12 Briefly, we prospectively recruited patients with a first-ever lacunar stroke at Maastricht University Medical Center from May 2003 to January 2008 and at Orbis Medical Center Sittard, The Netherlands from September 2004 to April 2007. Lacunar stroke was defined as an acute lacunar stroke syndrome with a small, deep infarct on MRI compatible with the clinical findings, or, if MRI did not show a compatible lacunar lesion, one of the established clinical lacunar stroke syndromes.…”

“…2,10 Previous studies showed that elevated BP levels are associated with each of the MRI markers of cSVD separately. [11][12][13][14] However, these studies did not provide an overall measure for the total burden of cSVD. Because these markers may occur simultaneously in a patient and are all considered to be caused by cSVD, it seems rather artificial to investigate the presence of only 1 MRI marker while disregarding the others.…”

In vivo iron quantification in collagenase‐induced microbleeds in rat brain

“…Brain microbleeds (BMB) are associated with ischemic and hemorrhagic stroke, cerebral amyloid angiopathy, neurotrauma, Alzheimer's disease, vascular dementia, cognitive decline, hypertension, and aging (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). The presence of BMB in ischemic stroke, intracerebral hemorrhage, and cerebral amyloid angiopathy is associated with future hemorrhage (2,(17)(18)(19).…”