Factors associated with the presence of cerebral microbleeds and its influence on outcomes of stroke not treated with alteplase

Nagaraja, Nandakumar; Farooqui, Amreen; Zahid, Abdullah Bin; Kaur, Supreet

doi:10.1016/j.clineuro.2021.106798

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…MRI images were obtained from 1.5 T Avanto or 3T Verio Siemens scanners as described in our previous study. 18 Stroke protocol MRI included DWI, fluid-attenuated inversion recovery imaging (FLAIR), and susceptibility-weighted imaging (SWI) sequences. Typical parameters for DWI were repetition time/echo time (TR/TE) = 4100/102 or 7300/80 or 8200/89 with b = 0 and 1000 s/mm 2 , 4-5 mm thickness; for FLAIR, TR/TE = 9000/90 or 9000/126, 4 mm thickness; and for SWI, TR/TE = 28/20 or 49/40, 3 mm thickness.…”

Section: Methodsmentioning

confidence: 99%

“… 20 As described in our previous study, circular, and homogenously hypointense lesions measuring 2-10 mm in diameter on SWI were identified as CMB. 18 The CMB mimics as described in MARS criteria were excluded. To exclude mimics such as calcium deposits, the hypointensities in the basal ganglia seen on MRI were compared to admission CT head.…”

Section: Methodsmentioning

confidence: 99%

“…To exclude mimics such as calcium deposits, the hypointensities in the basal ganglia seen on MRI were compared to admission CT head. 18 Hypointense lesions mimicking small vessels were followed through sequential slices.…”

Section: Methodsmentioning

confidence: 99%

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Standard clinical and imaging-based small vessel disease parameters associated with mild stroke versus non-mild stroke

Farooqui

Casul

Jain

et al. 2023

J Cent Nerv Syst Dis

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Background Mild stroke has variable outcomes, and there is an ongoing debate regarding whether the administration of thrombolytics improves outcomes in this subgroup of stroke patients. Having a better understanding of the features of mild stroke may help identify patients who are at risk of poor outcomes. Objective The objective of this study is to evaluate the association of clinical and imaging-based small vessel disease features (white matter hyperintensities and cerebral microbleeds) with stroke severity and clinical outcomes in patients with mild stroke. Methods In this retrospective study, mild stroke was defined as a National Institute of Health stroke scale (NIHSS) score <5. Clinical, laboratory and imaging data were compared between patients with mild stroke versus non-mild stroke (NIHSS≥5). Multivariate logistic regression analysis was performed to identify predictors of mild stroke and poor discharge outcome. Results Among 296 patients included in the study, 131 patients (44%) had mild stroke. On multivariate analysis, patients with mild stroke were three times more likely to have sensory symptoms [odds ratio (OR) = 2.9; 95% confidence interval (CI) = (1.2-6.8)] and four times more likely to have stroke due to small vessel disease (OR = 3.7; 95%CI = 1.4-9.9). Among patients with mild stroke, higher age (OR = 1.1; 95%CI = 1.02-1.1), presence of cerebral microbleed (OR = 4.5; 95%CI = 1.5-13.8), vertigo (OR = 7.3; 95%CI = 1.2-45.1) and weakness (OR = 5.0; 95%CI = 1.2-20.3) as presenting symptoms were more likely to have poor discharge outcome. Conclusion Sensory symptoms and stroke due to small vessel disease are more common in mild stroke than non-mild stroke. Among patients with mild stroke, presence of cerebral microbleeds on imaging and symptoms of muscle weakness are associated with poor discharge outcome. Larger studies are needed to assess the impact of cerebral microbleed on mild stroke outcomes and risk stratify the benefit of thrombolytics in this group.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Standard clinical and imaging-based small vessel disease parameters associated with mild stroke versus non-mild stroke

Farooqui

Casul

Jain

et al. 2023

J Cent Nerv Syst Dis

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“…Two investigators blinded to clinical history independently evaluated the DWI, SWI and FLAIR images. 18 Any discrepancies in the image reading were resolved by consensus. The white matter hyperintensity (WMH) was evaluated on the FLAIR sequence using the semiquantitative Fazekas rating scale (Table 1).…”

Section: Imaging Assessmentmentioning

confidence: 99%

“…MRI images were obtained from 1.5 T Avanto or 3 T Verio Siemens scanners as described in our previous study. 18 Stroke protocol MRI included DWI, FLAIR and SWI sequences. Typical parameters for DWI were: TR/TE = 4100/102 or 7300/80 or 8200/89 with b = 0 and 1000 s/mm 2 , 4-5 mm thickness; FLAIR TR/TE = 9000/90 or 9000/126, 4 mm thickness; and SWI, TR/TE = 28/20 or 49/40, and 3 mm thickness.…”

Section: Imaging Protocolmentioning

confidence: 99%

Kidney impairment and outcomes in acute ischaemic stroke

Nagaraja

Farooqui

Reddy

et al. 2022

Internal Medicine Journal

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Background: Chronic kidney disease (CKD) is associated with increased risk of stroke and mortality.Aims: To evaluate the clinical and imaging features and outcomes of patients with and without kidney impairment among t admitted for acute ischaemic stroke (AIS).Methods: AIS patients with brain magnetic resonance imaging (MRI) were included in the study. Kidney impairment was defined by an admission estimated glomerular filtration rate < 60 mL/min/1.73 m 2 . Cerebral microbleeds (CMB) and white matter hyperintensities (WMH) were evaluated using the Microbleed Anatomical Rating Scale and Fazekas scales, respectively. Primary outcomes were defined by modified Rankin Scale (mRS) and discharge disposition. Multivariate logistic regression analysis was performed to evaluate factors associated with the presence of kidney impairment and poor discharge outcomes.Results: Of the 285 patients with AIS, 80 had kidney impairment on admission.Patients with kidney impairment were older (mean age ± standard deviation: 74.7 ± 12.9 vs 64.4 ± 13.8 years, P < 0.0001) and had more neurological deficits on National Institutes of Health Stroke Scale (NIHSS) score (median 8.5 vs 5, P = 0.02). In unadjusted analysis, patients with kidney impairment were less likely to have a good functional outcome (mRS 0-2: 36% vs 57%, P = 0.002) and good discharge outcome (home or inpatient rehabilitation: 68% vs 82%, P = 0.008). On multivariate analysis, kidney impairment was associated with higher NIHSS score (odds ratio (OR) = 1.04; 95% confidence interval (CI) = 1.002-1.08) and severe WMH (OR = 1.99; 95% CI = 1.06-3.77) suggestive of small vessel disease, but kidney impairment was not associated with poor discharge outcome (OR = 1.62; 95% CI = 0.75-3.53). Conclusion:Presence of kidney impairment at the time of stroke presentation, regardless of previous renal function, is associated with more neurological deficits and severe WMH on MRI.

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