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Abstract
Cerebral microbleeds (CMBs) and white matter hyperintensities (WMH) are the most common manifestations of small vessel disease, and often co-occur in patients with cerebral vascular disease. Hypertension is widely accepted as a risk factor for both CMBs and WMH. However, the effect of hypertension on the association between CMBs and WMH remains unclear. We hypothesized that the relationship between CMBs and WMH is determined by hypertension. One hundred forty-eight patients with acute cerebrovascular disease who were admitted to PLA general hospital in Beijing, China from February 2010 to May 2011 were recruited in this study. CMBs on T2*-weighted angiography (SWAN) were assessed using the Brain Observer Microbleed Rating Scale criteria. The severity of the WMH was separately assessed as either peri-ventricular hyperintensities (PVH) or deep white matter hyperintensities (DWMH). The association among CMBs and the severity of WMH, and hypertension were determined. CMBs were found in 65 (43.9%) patients. The frequency of CMBs was related to the severity of DWMH and PVH. CMBs were more frequently observed in patients with hypertension compared to patients without hypertension (51.3% vs. 20.0%, p = 0.001). Hypertension was an independent risk factor for CMBs (odds ratio 5.239, p = 0.001) and DWMH (odds ratio 2.373, p = 0.040). Furthermore, the relationship between the presence of CMBs and the severity of DWMH was only found in patients with hypertension (r = 0.298, p<0.01). However, CMBs were associated with PVH independently of hypertension. This study demonstrated that hypertension determined the association between CMBs and DWMH.
Highlights
Cerebral microbleeds (CMBs) are focal deposits of hemosiderin in the brain, which is caused by a previous leakage of blood from small vessels, and are related to bleeding-prone microangiopathy of different origins [1]
Logistic regression analysis showed that age was an independent risk factor of CMBs and periventricular hyperintensities (PVH), and hypertension was independently associated with CMBs and deep white matter hyperintensities (DWMH) (Table 2)
The overall prevalence of CMBs was nearly 50%, which was higher than the prevalence in patients with ischemic strokes [5] and patients suspected of cerebrovascular disease in northeastern China [17]
Summary
Cerebral microbleeds (CMBs) are focal deposits of hemosiderin in the brain, which is caused by a previous leakage of blood from small vessels, and are related to bleeding-prone microangiopathy of different origins [1]. These hemosiderin deposits can be visualized as small, homogeneous, round foci of low signal intensity as assessed using the T2*-weighted gradient-recalledecho (GRE) and T2*-weighted angiography (SWAN) sequence of magnetic resonance imaging (MRI) [2,3,4]. We performed the present study to investigate the effect of hypertension on the association between CMBs and PVH and DWMH separately in elderly patients with acute cerebrovascular disease
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