Cerebral Microbleeds Are Predictive of Mortality in the Elderly

Altmann-Schneider, Irmhild; Trompet, Stella; Craen, Anton J. M. de; Es, Adriaan C.G.M. van; Jukema, J. Wouter; Stott, David J.; Sattar, Naveed; Westendorp, Rudi G.J.; Buchem, Mark A. van; Grond, Jeroen van der

doi:10.1161/strokeaha.110.595611

Cited by 117 publications

(76 citation statements)

References 33 publications

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“…Moreover, it seems that CMBs are often associated with a degree of surrounding tissue necrosis, which would concur with the growing literature refuting their presumed asymptomatic nature [30,31,32,33,34,35]. …”

Section: Discussionsupporting

confidence: 77%

Cerebral Microbleeds: Histopathological Correlation of Neuroimaging

Shoamanesh

Kwok²,

Benavente³

2011

Cerebrovasc Dis

238

160

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Background: In recent years, there has been a growing interest in cerebral microbleeds (CMBs) and their role in cerebrovascular disease. A few studies have investigated the histopathological correlation between CMBs and neuroimaging findings. We conducted a systematic review in an attempt to characterize the pathological and radiological correlation. Methods: A systematic literature search was conducted for studies in which CMBs were characterized histopathologically and correlated with MRI findings. Results: Five studies met the inclusion criteria, with a total of 18 patients. Hemosiderin deposition was reported in 42 CMBs (49%), while 16 CMBs (19%) were described as old hematomas which stained for iron, 13 (15%) had no associated specific pathology, 11 (13%) contained intact erythrocytes, 1 (1%) was due to vascular pseudocalcification, 1 (1%) was a microaneurysm and 1 (1%) was a distended dissected vessel. Lipofibrohyalinosis was the most prominent associated vascular finding. Amyloid angiopathy was present primarily in patients with dementia. Conclusions: Although histopathological associations have been observed using MRI in patients with CMBs, the findings have yet to be validated and further research is warranted.

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Section: Discussionsupporting

confidence: 77%

Cerebral Microbleeds: Histopathological Correlation of Neuroimaging

Shoamanesh

Kwok²,

Benavente³

2011

Cerebrovasc Dis

238

160

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“…3,4 In addition to these ischemic pathological changes, microbleeds-minor blood leakage through damaged blood vessels detectable via gradientecho T2*-weighted MRI-are observed relatively frequently in the general population 5 and have also been suggested to be a risk factor for stroke 6,7 and stroke-related mortality. 8 cSVDs arise from age-and hypertension-related small-vessel damage that shares cerebral amyloid angiopathy as a common cause. 9 In addition to these clinical risk factors and pathogenesis, postural instability in the elderly has also been postulated to be associated with cSVD, particularly with PVH.…”

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confidence: 99%

Association of Postural Instability With Asymptomatic Cerebrovascular Damage and Cognitive Decline

Tabara

Okada

O’Hara

et al. 2015

Stroke

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Background and Purpose-Asymptomatic cerebral small-vessel disease (cSVD) in elderly individuals are potent risk factors for stroke. In addition to common clinical risk factors, postural instability has been postulated to be associated with cSVD in older frail patients. Here, we conducted a cross-sectional study to understand the possible link between postural instability and asymptomatic cSVD further, namely periventricular hyperintensity, lacunar infarction, and microbleeds, as well as cognitive function, in a middle-aged to elderly general population (n=1387). Methods-Postural instability was assessed based on one-leg standing time (OLST) and posturography findings. cSVD was evaluated by brain magnetic resonance imaging. Mild cognitive impairment was assessed using a computer-based questionnaire, and carotid intima-media thickness as an index of atherosclerosis was measured via ultrasonography. Results-Frequency of short OLST, in particular <20 s, increased linearly with severity of cSVD (lacunar infarction lesion: none, 9.7%; 1, 16.0%; >2, 34.5%; microbleeds lesion: none, 10.1%; 1, 15.3%; >2, 30.0%; periventricular hyperintensity grade: 0, 5.7%; 1, 11.5%; >2, 23.7%). The association of short OLST with lacunar infarction and microbleeds but not periventricular hyperintensity remained significant even after adjustment for possible covariates (lacunar infarction, P=0.009; microbleeds, P=0.003; periventricular hyperintensity, P=0.601). In contrast, no significant association was found between posturographic parameters and cSVD, whereas these parameters were linearly associated with OLST. Short OLST was also significantly associated with reduced cognitive function independent of covariates, including cSVD (P=0.002). Conclusions-Postural instability was found to be associated with early pathological changes in the brain and functional decline, even in apparently healthy subjects. Correspondence to Yasuharu Tabara, PhD, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Shogoinkawaracho 53, Sakyoku, Kyoto 606-8507, Japan. E-mail tabara@genome.med.kyoto-u.ac.jp © 2014 American Heart Association, Inc. 16 has examined the association between lacunar infarction and postural instability, and no data are available on the association between microbleeds and postural instability, despite individuals with lacunar infarction and PVH being frequently complicated with microbleeds. 17Here, we conducted a cross-sectional study to understand the possible link between postural instability and asymptomatic cSVDs further-namely, PVH, lacunar infarction, and microbleeds-in a middle-aged to elderly general population. As we previously showed that individuals with mild cognitive impairment, particularly those with Alzheimer disease, were prone to instability while standing on 1 leg, 18 we attempted to gather more evidence in the present study. Methods Study SubjectsThe study subjects were 1387 apparently healthy middle-aged to elderly individuals who were consecutive participants in the medical checkup program a...

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“…Therefore, CMBs can be considered a marker for poor outcome. 2,[6][7][8][9][10][11][12] In cross-sectional studies, higher age and elevated BP levels were most consistently associated with the prevalence of CMBs. 3,5,13,14 However, longitudinal studies did not show a convincing association between elevated BP and the appearance of new CMBs.…”

mentioning

confidence: 99%

Higher Ambulatory Blood Pressure Relates to New Cerebral Microbleeds

Klarenbeek

Oostenbrugge

Rouhl

et al. 2013

Stroke

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, patients with a first-ever lacunar stroke were prospectively recruited for a lacunar stroke research project at Maastricht University Medical Center and Orbis Medical Center Sittard, the Netherlands. This study was approved by the local ethics committee, and informed consent was obtained from all patients. We defined lacunar stroke as an acute lacunar stroke syndrome with a recent, small (diameter <20 mm) infarct on MRI Background and Purpose-Elevated blood pressure (BP) is associated with the presence of cerebral microbleeds (CMBs) in cross-sectional studies. However, longitudinal studies did not show a convincing relationship. We aimed to determine the association between elevated BP levels and the occurrence of new CMBs after a 2-year follow-up in first-ever lacunar stroke patients using ambulatory BP monitoring. Methods-Ninety-six first-ever lacunar stroke patients underwent brain MRI and ambulatory BP monitoring at baseline and after 2-year follow-up. We used logistic regression analyses to assess the association of BP levels with new CMBs. Results-We found new CMBs in 17 patients (18%). Higher 24-hour, day and night systolic BP (odds ratio, 2.69; 95% confidence interval, 1.40-5.21 per SD increase for 24-hour BP) and diastolic BP (odds ratio, 2.13; 95% confidence interval, 1.15-3.90 per SD increase for 24-hour BP) at baseline were associated with the development of new CMBs independent of age and sex. BP levels decreased during follow-up in both patients with and without new CMBs. Unlike BP levels at baseline, there was no difference in BP levels at follow-up between patients with and without new CMBs. Conclusions-Both higher systolic and diastolic BP levels were associated with the development of new CMBs in a population of lacunar stroke patients. Decrease of BP levels during follow-up did not halt progression of CMBs; however, it remains to be determined whether (

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Cerebral Microbleeds Are Predictive of Mortality in the Elderly

Cited by 117 publications

References 33 publications

Cerebral Microbleeds: Histopathological Correlation of Neuroimaging

Cerebral Microbleeds: Histopathological Correlation of Neuroimaging

Association of Postural Instability With Asymptomatic Cerebrovascular Damage and Cognitive Decline

Higher Ambulatory Blood Pressure Relates to New Cerebral Microbleeds

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