Prevalence Of Cerebral Microbleeds Research Articles

Prior Antithrombotic Therapy Is Associated With Cerebral Microbleeds in Ischemic Stroke Patients With Atrial Fibrillation and/or Rheumatic Heart Disease.

Background and purpose: Cerebral microbleeds (CMBs) could contribute to an increased risk of intracerebral hemorrhage in patients with antithrombotic therapy (antiplatelets or anticoagulants). Antithrombotic agents are commonly prescribed to the patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) for preventing ischemic stroke. However, the impact of antithrombotic therapy on CMBs remained controversial. We aimed to explore the association between the prevalence of CMBs and prior antithrombotic therapy in ischemic stroke patients with AF and/or RHD.Materials and Methods: Ischemic stroke patients with AF and/or RHD within 7 days of onset from two hospitals were enrolled. Clinical information, prior use of antiplatelets or anticoagulation, presence and location of CMBs on susceptibility weighted imaging were recorded. We investigated the association of antithrombotic use with the presence or location of CMBs using multivariable logistic regression.Results: A total of 160 patients (68 males; median age, 71 years) were included. CMBs were observed in 90 (56.3%) patients, of whom 37 were with strictly lobar CMBs and 53 were with deep or infratentorial CMBs. There was a significant difference in antiplatelet use between patients with and without CMBs (33.3 vs. 11.4%, P = 0.001), but not found in anticoagulants. Prior use of antiplatelets was independently associated with the presence of CMBs (OR 3.075, 95% CI 1.175–8.045, P = 0.022) and especially strictly lobar CMBs (OR 2.635, 95% CI 1.050–6.612, P = 0.039) in multivariate analysis.Conclusions: The present study suggests that CMBs are common in ischemic stroke patients with AF and/or RHD and prior antiplatelet use may relate to the presence of CMBs predominantly in the strictly lobar region. Whether anticoagulants could cause CMBs need to be determined in future longitudinal studies.

Stroke : Highlights of Selected Articles

<i>Stroke</i> : Highlights of Selected Articles

Cerebral microbleeds and acute coronary syndrome: Screening and progression under dual antiplatelet therapy. Proof of concept study

Cerebral microbleeds (CMB) are associated with intracerebral hemorrhage. Therefore they may represent a concern if anticoagulant and/or antiplatelet therapy is needed. In addition, some risk factors for developing CMB are similar to those of coronary artery disease including age and hypertension. The aim of this study was to determine the prevalence of CMB in patients with acute coronary syndrome (ACS) and troponin elevation, and to follow their progression at 3 months under dual antiplatelet therapy. This prospective study included patients aged over 65 hospitalized in intensive cardiac care unit in Dijon, France, for ACS with troponin elevation. These patients underwent a first brain MRI (T2* and SWI) within 72 hours of admission, that was repeated 3 months after stenting. Sixty-eight patients (29 women and 39 men, mean age 77 years) were included between November 2016 and June 2017. The prevalence of CMB was 22%, with a female predominance of 80% vs. 33% ( P = 0.002). Patients with at least one acute CMB had significantly lower LDL-Cs and HDL-Cs levels than patients without CMB (1.1 ± 0.45 vs. 1.58 ± 0.96 g/L, P = 0.013 and 0.48 ± 0.29 vs. 0.68 ± 0.36 g/L, P = 0.045, respectively) but also renal function impairment (Cockroft-Gault creatinine clearance: 52.7 ± 27.7 vs. 73.4 ± 31.5 mL/min, P = 0.025), and higher risk CRUSADE score (45.4 ± 12.8 vs. 32.7 ± 14.5, P = 0.003). Multivariate analysis showed that only female sex was associated with the presence of a CMB on the initial MRI. On repeated MRI, an increase in CMB was observed in 7% of patients, but it was not statistically significant. The prevalence of CMB in patients with ACS is high (22% of patients over 65). MRI monitoring showed an increase in CMB numbers, which should be evaluated over longer series, but also over longer periods, taking into account risk factors for CMB development, and duration of antiplatelet treatment. For that purpose, additional patients are recruited in this study.

Blood Glucose Levels Are Associated with Cerebral Microbleeds in Patients with Acute Ischaemic Stroke

Background and Purpose: There are debates about the causative role of high blood glucose in cerebral small vessel disease. The relationship between cerebral microbleeds (CMBs) and blood glucose is unclear. Methods: Patients admitted to our department with acute ischaemic stroke were consecutively and prospectively included. Baseline demographic and clinical covariates were collected and analyzed according to the occurrence and location of CMBs and levels of blood glucose. Results: Of 161 patients included in the final analysis, 69 (42.76%) were women. A total of 80 patients (49.69%) had CMBs. There was a significant trend towards the prevalence of CMBs with increasing glucose quarter (p = 0.001). Post hoc analysis showed the rate of prevalence of CMBs to be significantly higher in the third quarter (OR 1.90, 95% CI 1.20–3.02) and fourth quarter (OR 1.65, 95% CI 1.21–2.25) than that in the first. The frequencies of deep or infratentorial CMBs differed with glucose quarter. Post hoc analysis showed that frequencies of deep or infratentorial CMBs were significantly more frequent in the third quarter (OR 1.76, 95% CI 1.06–2.87) and fourth quarter (OR 1.65, 95% CI 1.19–2.31) than those in the first. Conclusions: In this prospective study of patients with acute ischaemic stroke, our results showed that glucose was associated with deep or infratentorial CMBs but not with lobar CMBs.

Cerebral microbleeds: Prevalence and relationship to amyloid burden.

To describe the prevalence of cerebral microbleeds (CMBs) and determine the association between CMBs and β-amyloid burden on PET. From the population-based Mayo Clinic Study of Aging, 1,215 participants (53% male) underwent 3-tesla MRI scans with T2* gradient recalled echo sequences from October 2011 to February 2017. A total of 1,123 participants (92%) underwent 11C-Pittsburgh compound B (PiB)-PET scans. The prevalence of CMBs was derived by adjusting for nonparticipation and standardizing to the Olmsted County, MN, population. The relationship between β-amyloid burden and CMB presence and location was tested using logistic regression models. Ordinal logistic models tested the relationship between CMB frequency and β-amyloid burden. Two hundred seventy-four participants (22.6%) had at least one CMB. CMB frequency increased with age by decade (11% aged 60-69 years, 22% 70-79 years, and 39% 80 years and older). After adjusting for age, sex, and hypertension, PiB standardized uptake value ratio (SUVR) was associated with increased odds of a CMB. The association between PiB SUVR and CMBs was location-specific; PiB SUVR was associated with lobar CMBs but not deep CMBs. Age, hypertension, and PiB SUVR were associated with increasing CMB count. CMB density was greatest in parietal and occipital regions; β-amyloid burden correlated with concentration of CMBs in all lobar regions. Among participants with multiple CMBs, greater PiB uptake occurred in the pre- and postcentral gyri superiorly, the superior parietal lobe and precuneus, the angular gyrus, inferior temporal gyrus, and temporal poles. The prevalence of CMBs increases with age. In this population-based sample, β-amyloid load was associated with lobar but not with deep CMBs.

Cognitive dysfunction in atrial fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia in adults, and its incidence and prevalence increase with age. The risk of cognitive impairment and dementia also increases with age, and both AF and cognitive impairment or dementia share important risk factors. In meta-analyses of published studies, AF is associated with a 2.4-fold and 1.4-fold increase in the risk of dementia in patients with or without a history of stroke, respectively. This association is independent of shared risk factors such as hypertension and diabetes mellitus. Neuroimaging has illustrated several potential mechanisms of cognitive decline in patients with AF. AF is associated with increased prevalence of silent cerebral infarcts, and more recent data also suggest an increased prevalence of cerebral microbleeds with AF. AF is also associated with a pro-inflammatory state, and the relationship between AF-induced systemic inflammation and dementia remains to be investigated. Preliminary reports indicate that anticoagulation medication including warfarin can reduce the risk of cognitive impairment in patients with AF. Catheter ablation, increasingly used to maintain sinus rhythm in patients with AF, is associated with the formation of new silent cerebral lesions. The majority of these lesions are not detectable after 1 year, and insufficient data are available to evaluate their effect on cognition. Large prospective studies are urgently needed to confirm the association between AF and dementia, to elucidate the associated mechanisms, and to investigate the effect of anticoagulation and rhythm control on cognition.

Abstract P333: Effect of Autonomous Cortisol Secretion on Cerebrovasuclular Events in Patients With Primary Aldosteronism

Background: Primary aldosteronism (PA) display a higher risk of cerebrovascular events (CVE) compared with essential hypertension (EH).On the one hand, it was also reported that the PA patients associated with autonomous cortisol secretion had high incidence of CVE. Objective: Our objective was to investigate the effect of autonomous cortisol secretion on the prevalence of CVE in the patients with PA and/or Cushing syndrome (CS). Design and Setting: This was a retrospective cross-sectional study from Tohoku University Hospital between 2008 and 2017. Patient: 291 patients were analyzed. In the patients with PA, the recent continuous cases performed adrenal venous sampling (AVS) were extracted. They were divided into four groups. Group A: 32 CS patients, Group B: 34 PA patients with autonomous cortisol secretion, Group C:121 PA patients with aldosterone producing adenoma (APA) and Group D: 104 PA patients with idiopathic hyperaldosteronism (IHA). They were also performed and analyzed MRI brain scans during a hospitalization and examined 1-mg dexamethasone suppression test . The patients in Group A, B and C were underwent adrenalectomy. Results: In Group A and Group B, the female-to-male ratio was significantly high (about 4:1). The prevalence of symptomatic stroke prevalence of symptomatic stroke before the confirmed diagnosis in each group were as follows: Group A:2/32, Group B: 0/34, Group C:13/121 and Group D: 3/104. The unruptured cerebral aneurysms were detected in Group A:1/32, Group B: 0/34,Group C:2/121 and Group D: 3/104. Aside from this results, 3 patients underwent surgical clipping for unruptured cerebral aneurysms. During this follow-up period, 5 patients had new onset of CVE(cerebral infarction: 1, cerebellar hemorrhage: 4) in Group C albeit carried out adrenalectomy. In comparison with MRI findings between Group A and B, we found no significant difference in the prevalence of Cerebral microbleeds (CMBs:5.8-9.3%) and High grade white matter hyperintensities (HWHs:43-50%). Conclusion: In this study, we could not demonstrate that the patients with PA associated with autonomous cortisol secretion had high incidence of CVE. Nevertheless, we demonstrate that the patients with APA had relatively high incidence of CVE.

Incidental Findings on Brain MRI Among Chinese at the Age of 55-65 Years: The Taizhou Imaging Study

Background: Asymptomatic brain abnormalities are common incidental findings on brain MRI in the elderly population and can be regarded as imaging markers of early stroke and dementia. We initiated the Taizhou Imaging Study (TIS) to examine the prevalence and correlates of incidental findings using brain MRI among an elderly population residing in a rural area of China. Methods: A total of 562 individuals, at the age of 55 to 65 years, participated in the TIS study with a response rate of 90%. The primary findings included lacunes, white matter hyperintensity (WMH), and cerebral microbleeds (CMB), perivascular space (PVS), intracranial arterial stenosis (ICAS), and others (venous angioma, etc.). The brain parenchymal fraction and the brain gray matter fraction (BGMF) were also estimated. Findings: The prevalence of lacunes, WMH, CMB, PVS, and ICAS was 26.69%, 10.68%, 18.51%, 27.76%, and 12.81%, respectively. Age and hypertension were the major correlates of these incidental findings. Per each year increase in age, the risks of WMH and CMB increased by 15% and 14%. Compared to individuals with normal blood pressure, individuals with hypertension had an increased risk of all incidental findings, with the adjusted odds ratios of 2.28 to 5.45. Correlations of age, gender and BMI with BGMF were also observed. Interpretation: The prevalence of MRI incidental findings was high in the rural Chinese population at the age of 55-65 years. The high prevalence of these findings indicates a need of preventative strategy to help prevent future stroke and dementia in this population. Funding: The project was supported by the International Science and Technology Cooperation Program of China (grant number: 2014DFA32830), the Key Research and Development Plans of Jiangsu Province (grant number: BE2016726), the key basic research grants from Science and Technology Commission of Shanghai Municipality (grant number: 16JC1400500), the Karolinska Institutet (Senior Researcher Award and Strategic Research Area in Epidemiology), and the National Key Research and Development program of China (grant number: 2017YFC0907002, 2017YFC0907501). Declaration of interests: We declare no competing interests. Ethical Approval Statement: This study was approved by the Human Ethics Committee of School of Life Sciences of Fudan University (number of Institutional Review Board approval: 469).

Large Vessel Disease Modifies the Relationship Between Kidney Injury and Cerebral Small Vessel Disease.

Background: Recent studies have shown that renal disease is associated with magnetic resonance imaging (MRI) markers of cerebral small vessel disease (CSVD), independent of traditional vascular risk factors. Although large artery lesions might be involved in the cerebrorenal association, evidence has been lacking.Methods: A total of 928 participants from a population-based cohort study were included. Kidney injury measurements included urinary albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). CSVD was assessed on MRI by white matter hyperintensity volume (WMHV), lacunes, brain parenchymal fraction (BPF), cerebral microbleeds (CMBs), and perivascular space. Carotid plaques and brachial-ankle pulse wave velocity (baPWV) were used to assess large artery atherosclerosis and stiffness. Multivariable linear and logistic regression and additional interaction models were used for statistical analysis.Results: Individuals with elevated ACR had higher prevalence of lacunes and more WMHV (p = 0.001 and 0.000, respectively), those with decreased eGFR had smaller brain volume, higher prevalence of lacunes and deep CMBs (p = 0.009, p = 0.017) and p = 0.010 respectively). Interaction analysis revealed that carotid plaque and baPWV significantly enhanced the association between eGFR and BPF (p = 0.001 and p = 0.002, respectively), that is, the association of eGFR with BPF was only significant among participants with carotid plaque and higher baPWV. In addition, carotid plaque enhanced the association between ACR and WMHV (p = 0.034) and baPWV enhanced the association between ACR and the presence of lacunes (p = 0.027). Modifying effect of large vessel disease markers on the association between kidney injury measurements and CMBs was not significant.Conclusion: Evaluation of subclinical CVSD in individuals with kidney injury is warranted, especially in those with combined large artery disease.

Racial Difference in Cerebral Microbleed Burden Among a Patient Population in the Mid-South United States

BackgroundAlthough intracerebral hemorrhage (ICH) is more common among African-Americans, data on the burden of cerebral microbleeds (CMBs) among different races is limited. The purpose of this study is to compare the number, associated factors, and topography of CMBs between African-American and Caucasian populations in the Mid-South United States. MethodsUsing natural language processing, we extracted all brain MRIs performed during a 2-year period (2012-2013) when the report indicated the presence of CMB. All the extracted MRI studies were evaluated for number and location of CMBs, prior stroke, and deep white matter lesion. Negative binomial regression was used to model for the overdispersed count data. ResultsA total 167 patients (mean age was 63 ± 15 years, 49% men, 77% African-American, median CMB count: 8) with 1 or more CMBs on their brain MRI were included in this study. There was no significant difference between the 2 groups in terms of CMB locations (P = .086), but there was a significant difference between African-American and Caucasian patients in terms of number of CMBs (16.5 ± 18 versus 6.5 ± 5.5, P < .001). The prevalence of multiple CMBs (CMBs ≥ 5) was similar among African-Americans and Caucasians (72% versus 55%, P = .062). After adjusting for potential confounders, the African-American race was not independently associated with a higher CMB burden (P = .073). ConclusionAfrican-American race was not independently associated with a higher rate of CMB burden when compared to Caucasians after adjusting for potential confounders. We also did not observe a significant racial difference regarding the location and prevalence of multiple CMBs (CMBs ≥ 5).

Prevalence and Risk Factors of Cerebral Small Vessel Disease in a Chinese Population-Based Sample.

Background and PurposeEpidemiological data of cerebral small vessel disease (CSVD) in the general population of China are lacking. We report on the prevalence of lacunes, white matter hyperintensity (WMH), and cerebral microbleeds (CMBs) in a community-based sample in China and compare the results with those of other studies. MethodsThis was a cross-sectional analysis of the population-based Shunyi Study in China. A total of 1,211 stroke-free participants (mean age, 55.6±9.3 years; 37.4% men) with available 3 Tesla (3T) magnetic resonance images were included in this analysis. Demographic information and risk factor data were assessed. The overall and age-specific prevalence of lacunes, WMH, and CMBs was evaluated. Associations between cardiovascular risk factors and the presence of these lesions were analyzed by multiple logistic regression. ResultsOur study showed a prevalence of 14.5% for lacunes, 72.1% for periventricular hyperintensity (PVH), 65.4% for deep white matter hyperintensity (DWMH), and 10.6% for CMBs. When compared with other community-based samples, individuals in the same age group showed a higher burden of lacunes and a relatively lower prevalence of CMBs. Advanced age was independently associated with the prevalence of these CSVD markers, while the presence of hypertension increased the risk of lacunes, PVH/DWMH, and CMBs in deep or infratentorial locations. ConclusionsA higher burden of lacunes but a relatively lower prevalence of CMBs was observed in this Chinese population. This notable result highlights the challenge of CSVD prevention in China. Chinese have a risk factor profile for CSVD similar to those in other populations.

The relationship of cerebral microbleeds to cognition and incident dementia in non-demented older individuals.

Cerebral microbleeds (CMB), suspected markers of hemorrhage-prone microangiopathy, are common in patients with cerebrovascular disease and in those with cognitive impairment. Their longitudinal relationship with cognitive decline and incident dementia in non-demented community-dwelling older individuals has been insufficiently examined. 302 adults aged 70-90 participating in the population-based Sydney Memory and Ageing Study underwent a susceptibility-weighted imaging (SWI) MRI sequence. The relationship of CMB with performance on neuropsychological tests was examined both cross-sectionally and longitudinally, over a mean of 4years. The association with cases of incident dementia during this period was also examined. The prevalence of CMB was 20%. In cross-sectional analysis, after adjusting for demographics and vascular risk factors, there was a significant association between the presence of CMB and poorer executive function. CMB were not associated with global cognition or other cognitive domains. On longitudinal analysis, after adjusting for demographics and vascular risk factors, there was a greater decline in visuospatial ability in those with CMB compared to those without. The presence of CMB was not associated with increased progression to dementia. CMB are associated with impairments in specific cognitive domains: executive function and decline in visuospatial ability, independent of other markers of CVD including white matter hyperintensities. This suggests a direct contribution of CMB to cognitive impairment although no significant difference in incident dementia rates was observed.

Prevalence of and risk factors for cerebral microbleeds in a general Japanese elderly community.

We investigated the prevalence of and risk factors for cerebral microbleeds (CMBs) in a cross-sectional study of a general population of Japanese elderly. In 2012, brain MRI scanning at 1.5T and comprehensive health examination were conducted for 1281 residents aged 65 years or older. CMBs were defined as ovoid hypointensity lesions less than 10 mm in diameter on T2*-weighted images and classified into deep/infratentorial or lobar CMBs. Age- and sex-specific and overall prevalence of CMBs were estimated, and the associations of traditional cardiovascular risk factors and APOE polymorphism with the presence of CMBs were examined using a logistic regression analysis. The crude prevalences of total, deep/infratentorial, and lobar CMBs were 18.7% (n = 240), 13.5% (n = 173), and 9.6% (n = 123), respectively. The prevalence of total CMBs was 23.0% in men and 15.5% in women and increased with aging in both sexes (both p for trend <0.01). Hypertension was significantly associated with the presence of both deep/infratentorial and lobar CMBs. Lower serum total cholesterol was a significant risk factor for deep/infratentorial CMBs, but not for lobar CMBs, while APOE ε4 carriers had a significantly higher likelihood only of lobar CMBs compared with noncarriers. Our study suggests that approximately 1 of 5 Japanese elderly people have CMBs, and that risk factors for deep/infratentorial and lobar CMBs are different, indicating the distinct pathologic backgrounds of these lesions.

Association of Chronic Kidney Disease With Small Vessel Disease in Patients With Hypertensive Intracerebral Hemorrhage.

Chronic kidney disease (CKD) has been closely associated with hypertension and stroke. Although studies have reported the relationship between CKD and cerebral small vessel disease (SVD), the link between CKD, hypertension, and SVD is uncertain. The aim of this study was to investigate the association between CKD and SVD in patients with strictly hypertensive intracerebral hemorrhage (ICH). 142 patients with acute hypertensive ICH were enrolled in this study. Magnetic resonance imaging was performed to assess imaging markers for SVD. Patients were categorized into three CKD groups based on the degree of kidney dysfunction [glomerular filtration rate (GFR) in milliliters per minute per 1.73 m2]: normal kidney function (GFR ≥ 90), mild kidney disease (60 ≤ GFR < 90), and moderate to severe kidney disease (GFR < 60). The prevalence rate of mild and moderate to severe CKD was 50 and 14.8%, respectively. The stage of CKD was associated with history of chronic hypertension (p = 0.046) as well as the prevalence rate of overall and deep cerebral microbleed (CMB) (p = 0.001 and p = 0.002, respectively). The stage of CKD was a significant risk factor for deep white matter hyperintensity (WMH) (OR 1.848; 95% CI 1.022-3.343, p = 0.042), overall CMB (OR 2.628; 95% CI 1.462-4.724, p = 0.001), lobar CMB (OR 2.106; 95% CI 1.119-3.963, p = 0.021), and deep CMB (OR 2.237; 95% CI 1.263-3.960, p = 0.006), even after adjustment for confounders. In patients with hypertensive ICH, the prevalence of CKD is high even at the early stage of renal function impairment and is associated with the prevalence of CMB and deep WMH. These results reinforce the notion of a link between hypertensive vasculopathy, renal function impairment, and cerebral SVD.

Association Between Cerebral Microbleeds and Depression in the General Elderly Population: A Meta-Analysis.

It remains unclear whether cerebral microbleeds (CMBs) are associated with depression in the general elderly population. We thus performed a meta-analysis to evaluate the relationship between depression and CMBs. A systematic literature search was conducted in EBSCO, PubMed, and Web of Science for relevant studies that assessed the relationship between depression and the prevalence of CMBs. Five eligible studies including 7,328 patients were pooled in meta-analysis. The prevalence of CMBs was 18.0%. The prevalence of depression was 11.1%. The pooled analysis demonstrated odds ratio for CMBs and depression to be 1.187 (95% confidence interval 1.005-1.403; p = 0.043) with no evidence of statistical heterogeneity (I2 = 0.0%, p = 0.621). Our meta-analysis of available published data indicated an increased prevalence of depression in the subjects with pre-existing CMBs. This finding supports the vascular depression hypothesis. Further studies are needed to investigate the role of CMBs in the pathogenesis and progression of depression, which might provide a potential target for the prevention and treatment.

Cerebral microbleeds and CSF Alzheimer biomarkers in primary progressive aphasias.

To reveal the prevalence and localization of cerebral microbleeds (CMBs) in the 3 main variants of primary progressive aphasia (PPA) (logopenic, semantic, and nonfluent/agrammatic), to identify the relationship with underlying Alzheimer pathology, and to explore whether CMBs contribute to language breakdown. We used a cross-sectional design in a multicenter cohort of 82 patients with PPA and 19 similarly aged healthy controls. MRI allowed for rating CMBs (2-dimensional gradient recalled echo T2*, susceptibility weighted imaging sequences) and white matter hyperintensities. CSF Alzheimer disease biomarker analyses available in 63 of the 82 patients provided the stratification of PPA into subgroups with patients who had or did not have probable underlying Alzheimer pathology. The prevalence of CMBs was higher in patients with PPA (28%) than in controls (16%). They were more prevalent in logopenic PPA (50%) than in semantic PPA (18%) and nonfluent/agrammatic PPA (17%). The localization of CMBs was mainly lobar (81%) with no difference between the PPA variants. CMBs were more frequent in PPA patients with positive than with negative CSF Alzheimer disease biomarkers (67% vs 20%). Patients with and without lobar CMBs had similar volumes of white matter hyperintensities. Language and general cognitive impairment in PPA was unrelated to CMB rates. CMB prevalence in PPA is higher than in healthy controls. CMBs were most prevalent in the logopenic variant, were related to underlying Alzheimer pathology, and did not affect the language/cognitive impairment. Our findings also suggest that CMB detection with MRI contributes to PPA variant diagnosis, especially of logopenic PPA, and provides an estimator of the underlying neuropathology.

Abstract TP199: Cerebral Microblees and Chronic Kidney Disease in Patients With First-ever Acute Ischemic Stroke or Transient Ischemic Attack

Introduction: Cerebral microbleeds (CMBs) are extravasations of cerebral small vessels that manifest as small round homogenous deposits of hemosiderin, shown as signal loss on magnetic resonance imaging (MRI) T2*-weighted gradient-recalled echo. CMBs is a potential predictor of symptomatic stroke. The frequency of CMBs increases with age, hypertension and history of cerebrovascular disease. Some studies indicated the relationship between the CMBs and chronic kidney disease (CKD), but it remains unclear in patients with first-ever acute ischemic stroke (AIS) or transient ischemic attack (TIA). Our hypothesis is that the presence of CMBs is relative to the severity of CKD in patients with first-ever AIS or TIA. Methods: A single center retrospective study of 456 consecutive Japanese patients (mean age 71 years, 58.6% male) with first-ever AIS or TIA and early underwent 1.5T MRI T2*-weighted gradient-recalled echo were enrolled. CMBs were defined as homogeneous round signal-loss lesions with a diameter of &lt;10 mm on 1.5T MRI T2*-weighted gradient-recalled echo. CKD stages were classified as normal (glomerular filtration rate (GFR): ≥90 mL/min/1.73 m 2 ), mild CKD (GFR: 60-89.9 mL/min/1.73 m 2 ), moderate CKD (GFR: 30-59.9 mL/min/1.73 m 2 ), and severe CKD (GFR: &lt;30 mL/min/1.73 m 2 ). Multivariable logistic regression was used to determine associations of CMBs and severity of CKD and reported with odds ratios (OR) and 95% confidence intervals (CI). Results: The prevalence of CMBs in 141 (30.9%) of patients (10.5% had one CMBs, 10.5% had 2-4 CMBs and 9.9% had ≥5 CMBs), 7.4% strictly lobar CMBs and 23.5% deep/infratentorial CMBs. Compared with the reference group of normal, mild CKD (OR 2.54, 95% CI 1.17-6.15), moderate CKD (OR 2.87, 95% CI 1.20-7.51), and severe CKD (OR 5.95, 95% CI 1.68-21.7) were associated with the presence of deep/infratentorial CMBs but not strictly lobar CMBs. Conclusions: The presence of deep/infratentorial CMBs was significantly associated with severity of CKD in this population of first-ever AIS or TIA.

The Prevalence of Cerebral Microbleeds in Non-Demented Parkinson's Disease Patients.

BackgroundCerebral microbleeds (CMBs) are associated with cerebrovascular risk factors and cognitive dysfunction among patients with Parkinson's disease (PD). However, whether CMBs themselves are associated with PD is to be elucidated.MethodsWe analyzed the presence of CMBs using 3-Tesla brain magnetic resonance imaging in non-demented patients with PD and in age-, sex-, and hypertension-matched control subjects. PD patients were classified according to their motor subtypes: tremor-dominant, intermediate, and postural instability-gait disturbance (PIGD). Other cerebrovascular risk factors and small vessel disease (SVD) burdens were also evaluated.ResultsTwo-hundred and five patients with PD and 205 control subjects were included. The prevalence of CMBs was higher in PD patients than in controls (16.1% vs. 8.8%; odds ratio [OR], 2.126; P = 0.019); CMBs in the lobar area showed a significant difference between PD patients and controls (11.7% vs. 5.9%; OR, 2.234; P = 0.032). According to the motor subtype, CMBs in those with PIGD type showed significant difference from controls with respect to the overall brain area (21.1% vs. 8.9%; OR, 2.759; P = 0.010) and lobar area (14.6% vs. 4.9%; OR, 3.336; P = 0.016). Among PD patients, those with CMBs had higher age and more evidence of SVDs than those without CMBs.ConclusionWe found that CMBs are more frequent in PD patients than in controls, especially in those with the PIGD subtype and CMBs on the lobar area. Further study investigating the pathogenetic significance of CMBs is required.

The Prevalence and Characterization of Cerebral Microbleeds in Young People Having Intracerebral Hemorrhage.

ObjectiveCerebral microbleeds (CMBs) are known as the neuroimaging markers of risk in stroke and dementia. Many studies on CMBs in elderly patients with hemorrhagic or ischemic stroke have been reported; however, reports on CMBs in young populations with intracerebral hemorrhage (ICH) are lacking.Materials and MethodsA total of 272 patients aged 18–54 years presented to our hospital with ICH between December 2009 and August 2017. Among these, CMB presence, count, and topography with respect to ICH were evaluated on magnetic resonance imaging (MRI) gradient echo images (GREs). We also evaluated the prevalence and risk factors of CMBs.ResultsAmong 272 patients, only 66 underwent GRE T2-weighted MRI. CMBs were detected in 40 patients (61%), with 29 (73%) being of the multifocal type. Among the 219 CMBs, 150 (68.5%) were of the deep type and 69 (31.5%) of the lobar type. CMB prevalence was higher in men. In multivariate logistic regression analysis, history of hypertension (adjusted odds ratio [aOR], 4.048; 95% confidence interval [CI], 1.14–14.32; p = 0.030), and male sex (aOR, 4.233; 95% CI, 1.09–16.48; p = 0.037) were independently associated with CMBs.ConclusionIn young patients who presented with spontaneous ICH, CMBs were highly prevalent in 61% of patients and strongly associated with history of hypertension and male sex.

Prevalence of and risk factors for cerebral microbleeds among adult patients with haemophilia A or B.

Cerebral microbleeds (CMBs) represent clinically silent haemorrhagic events. Cerebral microbleeds (CMBs) portend negative neurovascular and cognitive outcomes in the general population and are associated with cognitive impairment in persons with haemophilia (PWH). Prevalence, patterns, and risk factors for CMBs in PWH have not been directly compared to persons without coagulopathy. To examine prevalence, patterns, and risk factors for CMBs in PWH vs normal controls. Adults with haemophilia A or B and haemostatically normal controls were recruited. Subjects were excluded if taking an antithrombotic agent other than low-dose aspirin (<100mg). All subjects underwent T2*MRI of the brain; scans were reviewed independently by two neuroradiologists blinded to subject group to determine the presence of CMBs. We recruited 31 PWH and 32 controls. Human immunodeficiency virus (HIV) and history of hepatitis C virus (HCV) infection were more prevalent in PWH; smoking was more common among controls. Cardiovascular (CV) risk factors were similar between groups. Prevalence of CMBs was 35% in PWH and 25% in controls (P=.42). Among PWH, advanced age, history of HCV infection, and CV risk factors were associated with CMBs. Multiple and large (>5mm) CMBs were seen only in PWH. Cerebral microbleeds (CMBs) are common in adults with haemophilia, but not clearly more prevalent than in haemostatically normal controls. In PWH, older age, HCV infection, CV risk factors, and the presence of an inhibitor were associated with CMBs. Large CMBs and multiple CMBs may be more prevalent in PWH than in the general population. The clinical impact of CMBs in PWH requires further study.