Cerebral microbleeds predict first-ever symptomatic cerebrovascular events

Nishikawa, Tomofumi; Ueba, Tetsuya; Kajiwara, Motohiro; Fujisawa, Ichro; Miyamatsu, Naomi; Yamashita, K

doi:10.1016/j.clineuro.2009.08.011

Cited by 36 publications

(38 citation statements)

References 27 publications

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“…In contrast, in our present study, the presence of CMBs was a significant and independent predictor of ICH but not of cerebral infarction. Because adjustment for baseline variables was not performed sufficiently for all the variables in the multivariate analysis of the previous studies, 15,16 those previous results cannot be simply compared with the results of our present study in which the baseline variables were adjusted using PS. 25 Even so, our results clearly indicated that the risk of hemorrhagic stroke was higher in hemodialysis patients with CMBs and also corroborated the aforementioned Figure.…”

Section: Discussioncontrasting

confidence: 52%

“…[12][13][14][15][16] To date, only 2 prospective studies 15,16 have analyzed the relationship between CMBs and subsequent strokes in stroke-free individuals as in our cohort, and both studies showed that CMBs strongly predicted the occurrence of future cerebral infarctions. In contrast, in our present study, the presence of CMBs was a significant and independent predictor of ICH but not of cerebral infarction.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been reported that CMBs predict the future risk of spontaneous intracerebral hemorrhage (ICH) and ischemic stroke (IS) in patients after ICH, 12,13 IS, [12][13][14] and transient ischemic attack, [12][13][14] as well as in strokefree individuals. 15,16 Although CMBs are being increasingly detected by the more frequent use of sensitive MRI techniques, the differences in the sensitivity of the MRI techniques used should be taken into consideration. Previous studies have reported that the prevalence of CMBs was 3.1% to 23.5% in healthy populations without cerebrovascular disease, 5,6,9 18% to 68% in patients with IS, 6,9 and 47% to 80% in patients with ICH.…”

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confidence: 99%

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Cerebral Microbleeds Predict Intracerebral Hemorrhage in Hemodialysis Patients

Naganuma

Takemoto

Shoji

et al. 2015

Stroke

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Background and Purpose-In hemodialysis patients, previous reports have described a high prevalence of cerebral microbleeds (CMBs), but no longitudinal studies have been performed to determine the clinical significance of CMBs in these patients. In this study, we investigated whether the presence of CMBs was a predictor of future strokes in hemodialysis patients. Methods-Cranial MRI, including T2*-weighted magnetic resonance imaging, was performed on 179 hemodialysis patients with no past history of cerebrovascular events. The patients were followed prospectively until death or renal transplantation. We used the Cox proportional hazards model with inverse probability of treatment weighting using the propensity score to compare the event-free survivals of patients with/without CMBs. For sensitivity analyses, stratification by propensity score quintile and regression adjustment were used. Results-CMBs were detected in 45 of the 179 patients. During a median follow-up period of 5.0 years, stroke occurred in 24 patients, including 12 with intracerebral hemorrhage and 12 with cerebral infarctions. Cox proportional hazards analysis with inverse probability of treatment weighting using the propensity score revealed that the presence of CMBs was a strong and significant predictor of intracerebral hemorrhage (hazard ratio, 26.53; 95% confidence interval, 2.88-244.90) but not cerebral infarction (hazard ratio, 0.91; 95% confidence interval, 0.25-3.34). Sensitivity analyses yielded similar results. Conclusions-This study showed that the presence of CMBs was an independent and strong predictor of intracerebral hemorrhage in stroke-free hemodialysis patients, indicating that hemodialysis patients with CMBs should be carefully monitored for future onset of intracerebral hemorrhage.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Cerebral Microbleeds Predict Intracerebral Hemorrhage in Hemodialysis Patients

Naganuma

Takemoto

Shoji

et al. 2015

Stroke

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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.…”

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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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“…Only 2 prospective studies investigated the association of microbleeds with subsequent stroke in people without a history of cerebrovascular events. 19,20 Both studies found thatBackground-Cerebral microbleeds are highly prevalent in people with clinically manifest cerebrovascular disease and have been shown to increase the risk of stroke recurrence. Microbleeds are also frequently found in healthy elderly, a population in which the clinical implication of microbleeds is unknown.…”

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confidence: 99%

Cerebral Microbleeds Are Associated With an Increased Risk of Stroke

et al. 2015

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509S troke is the second leading cause of death worldwide and the third most common cause of disability-adjusted lifeyears.1,2 Although stroke has an acute onset, there is abundant evidence for a long subclinical period in which cerebrovascular pathology accumulates and can be visualized on noninvasive brain imaging. Markers of subclinical cerebrovascular pathology that are known to increase the risk of ischemic stroke are white matter lesions and lacunes. 3 In the past decade, punctuate hemorrhagic lesions in the brain parenchyma, so-called cerebral microbleeds, have emerged as another manifestation of subclinical cerebrovascular pathology. 4 In contrast to white matter lesions and lacunes, microbleeds are thought to reflect the presence of both ischemic and hemorrhagic brain vasculopathy. 5,6 In addition, evidence suggests that the location of cerebral microbleeds provides more information on the type of underlying vasculopathy, ie, cerebral amyloid angiopathy (CAA) in the presence of lobar microbleeds and hypertensive arteriopathy when deep or mixed microbleeds are seen. 4,7,8 Editorial see p 479 Clinical Perspective on p 516There is a growing need to clarify whether microbleed presence indicates an increased risk of stroke, because this may provide new insights in the link between subclinical cerebrovascular pathology and stroke. So far, it is known that in patients with a history of stroke microbleed presence increases the risk of recurrent stroke, either hemorrhagic or ischemic. [9][10][11][12][13][14][15][16][17][18] Whether microbleeds are associated with an increased risk of stroke in community-dwelling elderly without a history of stroke remains unclear. Only 2 prospective studies investigated the association of microbleeds with subsequent stroke in people without a history of cerebrovascular events. 19,20 Both studies found thatBackground-Cerebral microbleeds are highly prevalent in people with clinically manifest cerebrovascular disease and have been shown to increase the risk of stroke recurrence. Microbleeds are also frequently found in healthy elderly, a population in which the clinical implication of microbleeds is unknown. Methods and Results-In the population-based Rotterdam Study, the presence, number, and location of microbleeds were assessed at baseline on brain MRI of 4759 participants aged ≥45 years. Participants were followed for incident stroke throughout the study period (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). We used Cox proportional hazards to investigate if people with microbleeds were at increased risk of stroke in comparison with those without microbleeds, adjusting for demographic, genetic, and cardiovascular risk, and cerebrovascular imaging markers. Microbleed prevalence was 18.7% (median count 1 In the population-based Rotterdam Study, we investigated whether cerebral microbleeds at various locations are associated with an increased risk of recurrent and first-ever ischemic stroke and intracerebral hemorrhage. Methods Study PopulationThe Rotterdam Study ...

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Cerebral microbleeds predict first-ever symptomatic cerebrovascular events

Cited by 36 publications

References 27 publications

Cerebral Microbleeds Predict Intracerebral Hemorrhage in Hemodialysis Patients

Cerebral Microbleeds Predict Intracerebral Hemorrhage in Hemodialysis Patients

Higher Ambulatory Blood Pressure Relates to New Cerebral Microbleeds

Cerebral Microbleeds Are Associated With an Increased Risk of Stroke

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