Risk Factors For Cerebral Microbleeds Research Articles

Prevalence and risk factors for cerebral microbleeds in elderly Chinese patients with arteriosclerotic cardiovascular diseases: A single-center study

ObjectivesPeople with arteriosclerotic cardiovascular diseases (ASCVD) frequently use antithrombotic agents and statins. The objective of the study was to explore the prevalence and risk factors of cerebral microbleeds (CMBs) in elderly (≥ 65 years old) Chinese people with ASCVD. Materials and methodsWe prospectively included 755 eligible participants with complete MRI data, and CMBs were discerned on the SWI sequence. Multivariate logistic regression was performed to analyze risk factors associated with CMBs. ResultsThe average age was 74.9 ± 9.5 years, and the prevalence of CMBs was 37.9% (286/755). Of those with CMBs, 65.0% (186/286) had strictly lobar CMBs, 35.0% (100/286) had deep or infratentorial CMBs with or without lobar CMBs. We divided CMBs into two groups according to their locations, lobar CMBs group (strictly lobar CMBs) and deep CMBs group (with or without lobar CMBs). Age per 10 years (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.17–1.72, p < 0.001), statin use (OR 1.54, 95% CI 1.05–2.26, p = 0.03), and lacunes (OR 1.70, 95% CI 1.09–2.68, p = 0.02) were associated with any CMBs. Age per 10 years (OR 1.33, 95% CI 1.10–1.63, p < 0.001), statin use (OR 1.67, 95% CI 1.12–2.50, p = 0.01), and white matter hyperintensities (OR 1.71, 95% CI 1.17–2.51, p < 0.01) were associated with lobar CMBs. Only lacunes were associated with deep CMBs (OR 3.29, 95% CI 1.85–5.87, p < 0.001). ConclusionsIn elderly people with risk factors of ASCVD, antithrombotic drug use was not associated with any CMBs, lobar CMBs, or deep CMBs. Statin use was correlated with lobar CMBs but not deep CMBs.

Analysis of Risk Factors for Cerebral Microbleeds and the Relationship between Cerebral Microbleeds and Cognitive Impairment.

(1) Background: Cerebral microbleeds (CMBs) are attracting increasing attention. Nevertheless, the risk factors for CMBs remain poorly identified, and the relationship between CMBs and cognitive impairment is still up for debate; (2) Objective: The present study analyzed the risk factors for CMBs and probed into the potential correlations between the presence, number, and location of CMBs and cognition; (3) Methods: This study enrolled 406 subjects who underwent both brain 3.0-T magnetic resonance imaging scans and cognitive testing. Spearman correlation was used to assess the relationship between the number of CMBs and cognition. Multiple linear regression was utilized to analyze the relationship between the regions of CMBs and each cognitive domain; (4) Results: Multivariate logistic regression analysis results showed that age (odds ratio (OR) = 1.045, 95% confidence interval (95%CI; 1.009, 1.082)), smoking (OR = 3.604, 95%CI (1.995, 6.509)), hypertension (OR = 3.607, 95%CI (2.204, 5.901)), total cholesterol (OR = 0.611, 95%CI (0.467, 0.799)), and Amyloid-β1-42 (Aβ1-42) (OR = 1.028, 95%CI (1.018, 1.037)) were the influencing factors of CMBs. Education years (OR = 0.959, 95%CI (0.930, 0.988)), white matter lesions (OR = 2.687, 95%CI (1.782, 4.051)), and CMBs (OR = 21.246, 95%CI (5.728, 21.576)) were the risk factors for cognitive impairment. Hypertension increased the probability of deep CMBs (OR = 12.54, 95%CI (2.21, 71.28)), while Aβ1-42 elevated the probability of lobar CMBs (OR = 1.02, 95%CI (1.00, 1.03)). There was a linear correlation between the number of CMBs and Montreal Cognitive Assessment scores (r = -0.756, p &lt; 0.001). However, CMBs in each region were not related to specific cognitive domains (p &gt; 0.05), except CMBs in the mixed group that were negatively correlated with attention (OR = -0.669, 95%CI (-0.034, -5.270)); (5) Conclusions: Taken together, serum Aβ1-42 levels are related to the presence of CMBs. Cognitive impairment is correlated with the number of CMBs rather than their region. These findings suggest that CMBs play a role in cognitive impairment and that CMBs mark the presence of diffuse vascular injury and neurodegenerative brain damage.

Meta-Analysis of the Relationship between the Prognosis of Acute Cerebral Infarction Intravenous Lysis and Cerebral Microbleeds Based on Intelligent Medical Care.

The accelerated pace of life leads to people's unhealthy living habits such as irregular diet, irregular work and rest, and fatigued work. The incidence of acute cerebral infarction (ACI) is increasing year by year. Intravenous thrombolysis is the best solution for clinical treatment of ACI, but intravenous thrombolysis increases the risk of cerebral microbleeds and even seriously damages the brain of patients. It is crucial to analyze the relationship between intravenous thrombolysis of ACI and cerebral microbleeds. Using intelligent medical methods such as BP neural network (BPNN), meta-analysis was carried out on the prognosis of ACI intravenous thrombolysis and cerebral microbleeds, and the basic data indicators, living habits indicators, and ACI intravenous thrombolysis indicators of ACI patients were analyzed. The experimental results showed that the odds ratios (OR) of systolic blood pressure before ACI intravenous thrombolysis, blood glucose concentration after ACI intravenous thrombolysis, diastolic blood pressure before ACI intravenous thrombolysis, and diastolic blood pressure after ACI intravenous thrombolysis on cerebral microbleeds after ACI intravenous thrombolysis were 0.97, 0.44, 0.13, and 0.07, respectively. Long-term intravenous thrombolysis with ACI, high systolic blood pressure after NIHSS thrombolysis with high scores, and blood glucose concentration before thrombolysis had OR >1, which were risk factors for cerebral microbleeds after intravenous thrombolysis with ACI. Therefore, paying attention to the risk factors of cerebral microbleeds during ACI intravenous thrombolysis can effectively reduce cerebral microbleeds after ACI intravenous thrombolysis and improve the treatment efficiency of ACI patients.

High Prevalence of Cerebral Microbleeds in Young Ischemic Stroke Patients.

Most studies of cerebral microbleeds place more emphasis on the elderly, which made it difficult to obtain data on youth, particularly young ischemic stroke patients. Our study sought to investigate the incidence and related risk factors of cerebral microbleeds in young ischemic stroke patients. Young ischemic stroke patients who sought medical advice at Beijing Chaoyang Hospital between June 2016 and September 2020 were included in our study. The clinical and imaging data of these patients were collected and assessed. These patients were grouped by cerebral microbleed presence, count, and location. Univariate and multivariate logistic regression analyses were performed to investigate the association between these groups and screen the influencing factors of cerebral microbleeds in young patients with ischemic stroke. Among the 187 young ischemic stroke patients, the prevalence of microbleeds was 16%. The presence of cerebral microbleeds was associated with hypertension (odds ratio [OR] 8.787, 95% confidence interval [CI] 1.016-76.006, P=0.048), lower estimated glomerular filtration rate (OR 0.976, 95%CI 0.957-0.995, P=0.014) and moderate/severe white matter hyperintensity (OR 10.681, 95%CI 3.611-31.595, P<0.001) in young ischemic stroke patients. Cerebral microbleeds were common in young ischemic stroke patients and were associated with hypertension, lower estimated glomerular filtration rate, and moderate/severe white matter hyperintensity.

Abstract TP138: Prevalence And Risk Factors Associated With Cerebral Microbleeds In Patients With Acute Respiratory Distress Syndrome

Introduction: Acute respiratory distress syndrome (ARDS) is associated with pulmonary vascular endothelial injury. Cerebral microbleeds (CMB) have been reported in patients with critical illness such as ARDS, particularly involving the splenium of the corpus callosum and immediate subcortical white matter. We aimed to examine the prevalence and risk factors of CMB in ARDS. Methods: We reviewed patient data from an ARDS registry at a tertiary medical center from January 2010 to October 2018. Patients were excluded if MRI imaging was motion degraded or did not include susceptibility weighted imaging (SWI) or T2*weighted gradient echo sequences. CMB were defined as hypointense SWI or T2* lesions &lt;5 mm. Microbleeds were labeled as diffuse if there were ≥10 present in a region. ARDS rescue therapies included extracorporeal membrane oxygenation, inhaled vasodilators, recruitment maneuvers, high frequency oscillatory ventilation, neuromuscular blockade, and proning. Univariate analysis was performed to examine association with CMB. Results: Of the 678 patients with ARDS, 61 had MRI’s meeting inclusion criteria. CMB were present in 12 patients, with median age 62.5 years. Ten patients had lobar CMB, of which 4 were diffuse and also involved the cerebellum. There were 3 patients with CMB in the corpus callosum, all involving the splenium, of which 2 were diffuse among patients who had diffuse lobar involvement. Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment scores did not differ between those with and without CMB, but ARDS rescue therapies were more commonly used in patients with CMB (66.7% vs 22.4%, p=.003). CMB was associated with acute cerebral ischemia on MRI (41.7% with CMB vs 10.2% without CMB, p=.008). Conclusions: CMB are common in ARDS, mostly involving the cerebral lobes and cerebellum. CMB might be associated with ARDS rescue therapies and higher risk for ischemic infarcts.

Abstract WP262: Three-dimensional Characterization Of Cerebral Microvasculature And Microhemorrhages

Introduction: Cerebral microhemorrhages (CMH) are the pathologic substrate of MRI-demonstrable cerebral microbleeds, and are thought to occur when integrity of cerebral microvessels is compromised, leading to deposits of hemosiderin/iron accumulating within brain tissue. The presence of CMH is associated with cognitive decline and ischemic and hemorrhagic stroke. Hypertension (HTN) is a major risk factor for cerebral microbleeds and has been linked to a more significant microbleed burden in patients. Despite the clinical significance of HTN and cerebral microbleeds, our understanding of HTN-induced microbleed formation remains limited, and the vascular origin of CMH remains obscure. Methods: We used a perfusion-based vascular label with tissue clearing to enable three-dimensional visualization of CMH with the surrounding microvascular network. Adult (18-month-old) C57BL/6J mice were administered angiotensin II to induce HTN (n=10) or PBS (n=10). Lectin-DyLight-649 was injected retro-orbitally to bind to the endothelial walls of all blood vessels in a mouse. Brains were cut into 1-mm thick sections, stained with Prussian blue to label CMH, cleared using iDISCO, and imaged via confocal microscopy. MATLAB and neuTube were used to quantify vessel diameters. Results: Using this methodology, we were able to collect three-dimensional transmission images of CMH that were colocalized with three-dimensional fluorescence images of the surrounding microvasculature. The average vessel diameter of the 5 nearest vessels to 17 different CMH was found to be 4.22±0.81 μm, which corresponds to capillary-size vessels. Conclusions: These data support a capillary origin for cerebral microhemorrhages in this mouse model. The capillary origin implies a role for the blood-brain barrier in the development of CMH and cerebral microbleeds in this model of HTN and aging. Three-dimensional imaging has substantial utility for improved understanding of CMH origin.

Abstract TP127: Hypertension Provokes Development Of Cerebral Microhemorrhages In A Mouse Model

Introduction: Cerebral microhemorrhages (CMH) are the pathological substrate for cerebral microbleeds, represent focal hemosiderin deposits on MRI, and are associated with increased risk of cognitive impairment and ischemic and hemorrhagic stroke. Aging and hypertension are the most common risk factors for cerebral microbleeds. In this study, we analyzed the effect of hypertension on the development of CMH in a mouse model of aging. Methods: Hypertension was induced in aged (17 months old) female and male C57BL/6J mice, via infusion of angiotensin II (ATII) at 1000 ng/kg/min via Alzet pump over four weeks. We further examined underlying mechanism by inhibiting ATII type 1 receptor (AT1R) with telmisartan, via drinking water for 4 weeks. We collected mouse brains and performed standard histology using Prussian blue staining to detect CMH formation at 20x magnification. We also examined correlations between CMH burden and systolic (SBP) and diastolic (DPB) blood pressures. Results: ATII infusion induced significant increases in SBP (121±4 mmHg to 159±6 mmHg; p&lt;0.001) and DBP (94±4 mmHg to 129±7 mmHg; p&lt;0.001). Telmisartan completely blocked ATII-induced blood pressure elevation. Hypertension increased the number of CMH (p=0.01) in male and female mice. In animals with ATII infusion, number of CMH were positively correlated with SBP (r=0.45, p=0.02) and DBP (r=0.47, p=0.01). Telmisartan reduced by 55% the number of ATII-induced CMH, but compared to controls, CMH number remained elevated (p=0.03) in telmisartan-treated animals. Conclusions: ATII-induced hypertension promotes the development of CMH in aged mice in a manner that appears dependent on the extent of hypertension. However, in the presence of ATII with ATIR blockade, CMH develops even in the absence of hypertension. These findings emphasize the importance of presence and extent of hypertension in development of CMH in aging, as well as the significance of non-AT1R-mediated pathways independent of hypertension in ATII-induced CMH.

Risk factors of cerebral microbleeds in young and middle-aged patients with hypertension

Background &amp; Objectives: This study aimed to explore the incidence and potential risk factors of cerebral microbleeds (CMBs) in young and middle-aged patients with hypertension. Methods: We retrospectively analyzed the clinical data of young and middle-aged patients with hypertension in the Department of Neurology, General Hospital of Western Theater Command, Chengdu, China between August 2018 and December 2020. The demographic baseline, laboratory parameters and clinical imaging data were collected. Microbleed anatomical rating scale (MARS) was applied to evaluate the presence, amount, and topographical distributions of CMBs. Results: Among 196 young and middle-aged patients with hypertension, 84 (42.9%) patients had CMBs. CMBs were more likely to occur in the deep brain tissue regions (41.8%), followed by lobar or infratentorial region. White matter hyperintensity (OR, 5.262; 95%CI, 1.314-21.075; P=0.019), abnormal lipid metabolism (OR, 3.832; 95%CI, 1.578-9.306; P=0.003), usage of anti-platelet aggregation drugs (OR, 2.947; 95%CI, 1.138-7.632; P=0.026), smoking history (OR, 3.218; 95%CI, 1.073-9.651; P=0.037), and hyperhomocysteinemia (OR, 1.415; 95%CI, 1.018-1.967; P=0.039) were independently associated with deep or infratentorial CMBs in young and middle-aged patients with hypertension. However, the occurrence of strictly lobar CMBs was only independently associated with abnormal lipid metabolism (OR, 4.162; 95%CI, 1.685-10.282; P=0.002). Conclusions: The rate of CMBs was high in young and middle-aged patients with hypertension, most commonly occurring in the deep brain tissue region. While multiple risk factors were identified to be associated with deep or infratentorial CMBs, the occurrence of strictly lobar CMBs was only associated with abnormal lipid metabolism.

Prevalence and Risk Factors of Cerebral Microbleeds: Analysis From the UK Biobank.

To determine the prevalence of and risk factors for cerebral microbleeds (CMBs) at different locations in a large healthy community population. A total of 8,159 participants from the UK Biobank with MRI scans suitable for CMB analysis were included. Brain susceptibility-weighted imaging data were acquired on 2 identical 3.0T scanners. The Microbleed Anatomical Rating Scale was used to identify definite CMBs. Generalized linear models were used to determine independent associations with all CMBs and lobar, deep, and infratentorial CMBs. The mean age at scan was 62.1 ± 7.4 years. One or more definite CMBs were detected in 572 (7.0%) participants. Of those with CMBs, 439 (76.7%) had lobar CMBs, 103 (18.0%) had deep CMBs, and 83 (14.5%) had infratentorial CMBs. Age was an independent risk factor for CMBs in all locations. APOE4 and male sex were positively associated and higher body mass index was negatively associated with lobar CMBs. Hypertension, smoking, and alcohol consumption were associated with deep CMBs, but not with lobar CMBs. Only age was associated with infratentorial CMBs. The associations were unchanged after controlling for white matter hyperintensity lesion volume as a marker of small vessel disease severity. In this large population-based study, CMB prevalence detected using a low sensitivity and high specificity system was 7%. There were distinct risk factor profiles for CMBs in lobar and deep locations consistent with different underlying pathophysiologic processes. Clinical Trial registration number: UK Biobank application number 19463.

The Prevalence and Risk Factors of Cerebral Microbleeds: A Community-Based Study in China.

IntroductionCerebral microbleeds (CMBs) are frequently found in the healthy elderly. However, data on the prevalence and risk factors of CMBs in the general population of China are lacking.MethodsA cross-sectional study focusing on the prevalence and risk factors of CMBs was conducted in stroke-free elderly from Shanghai Wuliqiao community. MRI was performed at 3Tesla and cardiovascular risk factors (eg, age, smoking history, and hypertension), cerebral small vessel disease (CSVD) markers (eg, white matter hyperintensities, lacunar infarction, and enlarged perivascular space) and genetic information (eg, APOE, CR1) were recorded. Poisson regression was used to analyze the risk factors of the presence and location of microbleeds.ResultsA total of 199 participants (70.8±7.2 years old; male 31.2%) were finally included in our analysis. The overall prevalence of CMBs was 12.6% (25/199) and increased with age from 7.5% (55–64 years old) to 19.3% (over 75 years old). Of those with CMBs, most of them (16/25) located in the deep/mixed region and had 1–2 CMBs (18/25). Poisson regression analysis showed that white matter hyperintensities (OR=1.22, 95% CI: 1.16–1.29), APOE ε4+ carrier (OR=2.16, 95% CI: 1.18–3.96) and CR1 non-F/F isoform (OR=7.78, 95% CI: 4.34–13.96) were associated with CMBs. Further analysis found that in addition to the above three risk factors, hypertension (OR=2.98, 95% CI: 1.16–7.64), lacunar infarction (OR=2.39, 95% CI: 1.19–4.81) also increased the risk of deep/mixed CMBs.ConclusionThe prevalence of cerebral microbleeds is similar to other countries. Cardiovascular risk factors, CSVD markers, and genetic factors (APOE ε4, CR1 non-F/F isoform) were associated with CMBs, suggesting an interaction of multiple pathogenesis in Chinese stroke-free community population.

The clinical risk factors of cerebral microbleeds and its relationship with cognitive dysfunction

AbstractBackgroundTo explore the risk factors of cerebral microbleeds (CMBs) and the relationship between CMBs and cognitive impairment, and to provide more theoretical basis for the prevention and treatment of CMBs and vascular cognitive impairment.MethodThe CMBs group was classified according to the number and location. The basic clinical data were collected and the subjects all received the cognitive tests using Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and the Neuropsychological Assessment Scales.ResultA total of 138 subjects [71 participants in CMBs group and 67 as control] were enrolled, with an average age of 64.36±10.14 years. Ordered logistic regression analysis showed diastolic blood pressure (OR=1.05, 95% CI: 1.01‐1.09), history of ischemic stroke and transient ischemic attack (TIA) (OR=7.74, 95% CI: 2.74) ‐21.88), white matter hyperintensities (OR = 2.01, 95% CI: 1.46‐2.78) are independently associated with CMBs (P&lt;0.05). Spearman correlation analysis showed that MMSE, MoCA, memory and executive function were correlated with CMBs (MMSE r=‐0.24, P=0.005; MoCA r=‐0.32, P&lt;0.001; memory r=‐0.28, P=0.001; execution function r = ‐0.33, P&lt;0.001). Multivariate linear regression analysis showed that MoCA score, memory and executive function were negatively correlated with CMBs number after adjusting for gender, age, years of education, other imaging biomarkers of cerebral small vessel disease and vascular risk factors (MoCA β=‐0.88, P=0.012; memory β = ‐0.22, P = 0.002; executive function β = ‐0.13, P = 0.001). As for the location, the results showed that the executive function of patients with strict lobe CMBs was lower than that of control group (P=0.046). In terms of speed and motion control, the differences between deep group and control group (P=0.037), deep group and infratentorial group (P=0.005) were statistically significant.ConclusionDiastolic blood pressure, history of ischemic stroke / TIA, white matter hyperintensities were independent risk factors for CMBs. CMBs are associated with cognitive dysfunction. CMBs in the strict lobe area are associated with the decline of executive function, and CMBs in the deep area are associated with the decline of speed and motor control ability.

Prevalence and Associated Risk Factors of Cerebral Microbleeds in Egyptian Patients with Acute Ischemic Stroke and Atrial Fibrillation

BackgroundFew studies addressed the prevalence of cerebral microbleeds (CMB) and associated risk factor profile in Egyptian ischemic cerebral stroke patients with atrial fibrillation (AF). MethodsThe prevalence of CMB was estimated in 150 cases of AF ischemic stroke patients and compared to the prevalence in 150 age- and sex-matched controls of ischemic stroke patients without AF. CMB-associated risk factors were identified by comparing AF ischemic stroke patients with and without CMB. All participants were subjected to complete general, neurological examination, and magnetic resonance imaging. ResultsThe prevalence of CMBs in ischemic stroke with and without AF was 40.7% and 49.3%, respectively. Age, hypertension, diabetes mellitus, past history of stroke, antiplatelet, anticoagulant, National Institutes of Health Stroke Scale, CHA2DS2VASc, and white matter lesions (WML) were significant risk factors associated with CMB on univariate analysis. On multivariable logistic regression analysis, age (odds ratio [OR] 1.1, confidence interval [CI] 1.02-1.13), hypertension (OR 3.2, CI 1.19-8.81), anticoagulant (OR 3.3, CI 1.17-9.40), and WML (OR 9.6, CI 3.49-26.3) were the only independent risk factors associated with the presence of CMBs. ConclusionsAF in ischemic stroke patients was not associated with higher prevalence of CMBs. Old age, hypertension, anticoagulant treatment, and WML were the independent risk factors associated with CMB in AF ischemic stroke patients. Our results suggest that elderly hypertensive AF ischemic stroke patients maintained on anticoagulant therapy should be screened for the incidence of CMBs and monitored regularly for the development of intracerebral hemorrhage.

Cerebral Microbleeds and Chronic Kidney Disease in Acute Ischemic Stroke Patients with Atrial Fibrillation

Background: Cerebral microbleeds (CMBs) are associated with the risk of intracerebral hemorrhage in stroke patients with atrial fibrillation (AF). We investigated the association between CMBs and chronic kidney disease (CKD) in patients with acute ischemic stroke and AF. Methods: We retrospectively examined consecutive patients with acute ischemic stroke and AF who underwent brain gradient-echo T2*-weighted magnetic resonance imaging. The number and distribution (lobar, deep or infratentorial, and mixed) of CMBs were assessed. Kidney function was assessed according to the estimated glomerular filtration rate (eGFR), which was calculated using a modified version of the Modification of Diet in Renal Disease equation. Results: Of the 357 included patients, 105 (29.4%) had CMBs. CKD (eGFR < 60 mL/min/1.73 m2) was found in 131 (36.7%) patients. Patients with CKD showed a higher prevalence of any form of CMB (41.2% versus 22.6%, P < .001), deep or infratentorial CMBs (19.9% versus 9.3%, P < .01), and mixed CMBs (14.5% versus 5.3%, P < .01) than those without CKD. After adjusting for age and other confounding factors, CKD was found to be independently associated with the presence of any form of CMB (odds ratio 1.89, P = .02) and mixed CMBs (odds ratio 3.10, P < .01). Moreover, moderate to severe CKD (eGFR < 45 mL/min/1.73 m2) was independently associated with the presence of multiple CMBs (odds ratio 2.31, P = .04). Conclusions: CMBs and CKD are common in acute ischemic stroke patients with AF, and CKD may be a risk factor for CMBs. Further longitudinal studies are needed to evaluate whether maintaining kidney function can prevent the development of CMBs.

Cerebral microbleeds and their influence on cognitive impairment in Dialysis patients.

Cerebral microbleeds (CMBs) in dialysis patients have recently attracted much attention, and the different locations of CMBs indicate different pathological processes. Previous studies on the relationship between CMBs and cognitive impairment (CI) in the general population and in dialysis patients have reported controversial results. A total of 180 chronic dialysis patients were enrolled in our study. Based on brain magnetic resonance imaging (MRI) analysis of CMBs, the patients were divided into 4 groups (without-CMBs group, strictly lobar group, strictly deep group, and mixed group). A wide range of cognitive tests was administered to evaluate cognitive function. The risk factors for CMBs were explored, and the correlation between CMB distribution and CI was investigated by regression analysis. The prevalence of CMBs was 32.8% in the total study population, 36.1% in the haemodialysis (HD) subgroup and 26.2% in the peritoneal dialysis (PD) PD subgroup. Sixteen subjects (8.9%) were classified as the lobar group, 12 subjects (6.7%) as the mixed group, and 31 subjects (17.2%) as the deep group. A significant association was shown between deep CMBs and impaired cognitive function, involving overall cognitive function, memory, language ability and executive function. Deep CMBs were significantly associated with dialysis vintage, mean arterial pressure (MAP) and lacunar infarcts number, while deep CMBs showed no correlation with dialysis modality and current heparin medication. Deep CMBs are closely associated with global and specific CI in dialysis patients. Blood pressure control may prevent deep CMBs and their associated CI.

Prevalence of and Risk Factors for Cerebral Microbleeds in Moyamoya Disease and Syndrome in the American Population

Background and Purpose: Cerebral microbleeds (CMB) are reported to be frequent in moyamoya disease (MMD) and moyamoya syndrome (MMS) in the Asian population. It is associated with an increased risk of intracerebral hemorrhage. The significance of CMB in MMD/MMS in non-Asian populations has not been well established. Our study aimed to investigate the prevalence of CMB in MMD/MMS in a moymoya cohort with a majority of non-Asians and to identify risk factors for developing a CMB and its predictive value for subsequent vascular events. Methods: The moyamoya database was compiled by screening for MMD/MMS among patients admitted to the Zale-Lipshy University Hospital at the University of Texas Southwestern Medical Center. We identified and analyzed data of 67 patients with MMD or MMS. Patients were characterized as CMB+ or CMB– based on MRI findings. In CMB+ patients, the total number and location of CMB were identified. Univariate and multivariate logistic regression were used to identify risk factors for developing CMB and whether CMB are associated with the development of subsequent vascular events. Results: Out of a total of 67 patients, 11 (16%) had CMB. Males had significantly higher odds of having CMB as compared to females (OR 1.76; 95% CI 1.40–24.3, p = 0.021). The incidence of CMB was also associated with age at diagnosis (mean age of CMB+ patients vs. CMB– patients: 44 vs. 34 years, respectively, p = 0.024), smoking (p = 0.006), and hemorrhagic stroke at presentation (p = 0.034). Logistic regression with multivariate analysis found that gender and age at diagnosis remained statistically significant. New ischemic events occurred in 2 (20%) out of 10 CMB+ patients and 13 (23%) out of 55 CMB– patients, respectively (p = 0.79). While 2 (3%) CMB– patients had a new cerebral hemorrhage during follow-up, none of the CMB+ patients did. Conclusions: CMB are less prevalent in MMD/MMS in the USA than in Asia. An older age at diagnosis and male gender were associated with CMB. The presence of CMB was not associated with an increased risk of a subsequent ischemic or hemorrhagic stroke.

Cerebral microbleeds are associated with blood pressure levels in individuals with hypertension

ABSTRACTObjective: Cerebral microbleeds (CMBs), which appear as small dot-like hypointense lesions, are strongly associated with cerebrovascular disease. Recently, numerous investigations have suggested that hypertension and age are risk factors for CMBs; however, whether blood pressure grade and age rank are related to the severity of CMBs remains unclear. The purpose of this research was to assess the association between cerebral microbleeds and blood pressure levels.Methods: In total, 460 consecutive hypertension patients (214 males and 246 females; aged 44–96 years, mean age 60.95 ± 6.82 years) from Lishui Central Hospital were enrolled and classified as CMB or non-CMB patients according to magnetic resonance imaging (MRI). Gradient echo T2*-weighted MRI was used to detect CMBs. Differences in blood pressure, CMB severity, and other patient characteristics were compared between the two groups. Multifactorial logistic regression was used to analyze the correlation between blood pressure and microbleeds.Results: In our study, CMB lesions were identified in 123 patients (26.7%), including 39 patients with CMB lesions located deep in the brain. In the hypertensive population, smoking is an independent risk factor for CMBs. Additionally, systolic blood pressure (SBP), diastolic blood pressure (DBP) and age are also independent risk factors for CMBs. Furthermore, a modest correlation was noted between the number of microbleeds and grade of hypertension.Conclusions: This study provides novel evidence that microbleed severity is associated with hypertension grade. This conclusion emphasizes the importance of antihypertensive therapy in hypertension patients to avoid an increase in CMBs.

Prevalence and Risk Factors of Cerebral Microbleeds in Patients with Nonvalvular Atrial Fibrillation: An Enhanced T2*-Weighted Angiography Imaging Study

Background/Aims: Cerebral microbleeds (CMBs) may predict the occurrence of intracerebral hemorrhage (ICH). Warfarin use may cause ICH. It is still controversial whether warfarin increases CMBs in atrial fibrillation (AF) patients. The study aimed to investigate the prevalence of CMBs and risk factors in AF patient population. Methods: This single retrospective center study included 113 patients with nonvalvular atrial fibrillation (NVAF) who were on outpatient treatment. CMBs were counted using 3D-enhanced T2*-weighted angiography (ESWAN) imaging. We compared clinical and radiological data between patients who used warfarin and not used warfarin with univariate analysis. The associations between clinical and radiological data and CMBs in NVAF population were analyzed with multivariate linear regression analyses. Results: Among 113 NVAF patients, CMBs were found in 33 (29.2%) patients; there were 53 patients who used warfarin for thromboembolism prevention and 60 patients with similar demographic features who did not use warfarin. CMBs on ESWAN MRI showed no significant difference between the 2 groups (p = 0.061). Patients with CMBs were older than patients without CMBs (p = 0.046), and the frequency of smokers (p = 0.028), hypertension (p = 0.029), previous ICH (p = 0.000), and leukoaraiosis (p = 0.020) in patients with CMBs were significantly higher than patients without CMBs. In multivariate linear regression analyses, previous ICH (β = 1.438, p = 0.000), age (β = 0.082, p = 0.000), hypertension (β = 0.956 p = 0.003), warfarin treatment (β = 0.849, p = 0.006), and smokers (β = 0.920, p = 0.016) were positive linear predictors of CMBs number levels in NVAF patients. Conclusion: The present data demonstrated that CMBs were associated with age, hypertension, warfarin treatment, smoking, and a history of ICH. We also found neither CHA2DS2-VASc score nor HAS-BLED score was associated with CMBs in patients with NVAF.

Abstract TP206: Prevalence and Predictors of Cerebral Microbleeds Among Racial Minorities With Ischemic Stroke and Transient Ischemic Attack

Background: Cerebral microbleeds (CMB) are associated with dementia and stroke. CMB are attributed to cerebral amyloid angiopathy (lobar CMB), and hypertensive angiopathy (deep CMB). Racial minorities (RM) have a higher prevalence and poorer control of vascular risk factors, thus CMB may differ in prevalence and distribution in RM. We determined the prevalence, burden and vascular risk factors of CMB across racial groups in patients with stroke and transient ischemic attack, and CMB influence in short term outcomes. Methods: We included 2001 consecutive (year 2009-2018) patients with a readable T2*gradient-echo MRI sequence. CMB rating followed standardized guidelines and grouped topographically into lobar, deep or infratentorial. Race was self-reported based on U.S. census procedures and categorized as White, Black or Other racial groups (ORG). Univariate analyses were done to compare vascular risk factors between CMB groups, and multivariate logistic regression analyses were used to relate CMB and short term functional (modified Ranking scale score &lt;3 vs. higher) and adverse hospital outcomes (pneumonia, UTI, DVT, death), across racial groups. Results: We observed CMB in 679 (34%) patients. The respective distribution in lobar, deep and infratentorial regions were: Whites (n=174; 67.2%, 20.7% and 12%); Blacks (n=374; 53%, 28.4% and 18.5%); ORG (n=131; 45.5%, 25.3% and 29.3%). Blacks and ORG with CMB were younger than Whites (66 and 66 vs 70; p&lt;0.01); and had higher prevalence of diabetes (44% and 41% vs 28%, p&lt;0.01). Blacks had higher prevalence of previous stroke when compared with Whites (36% vs 27%, p&lt;0.05). Patients with 10+ CMB, compared with no CMB and 1-9 CMB, had higher in-hospital pneumonia (8% vs 2.1% and 2.4% respectively; p=0.02) and were less likely to have mRS 0-2 at discharge (44.8% vs 55.3% and 48.7%; p=0.06). No difference was observed in mortality and other hospital adverse events. Conclusion: Racial minorities had higher proportion of CMB in non-lobar regions, suggesting that RM are more likely to have hypertensive angiopathy. RM with CMB were younger and differed in several risk factors compared to Whites. High CMB burden affected adversely outcomes. Further studies are needed to better characterize the clinical impact of CMB in RM.

Author response: Prevalence of and risk factors for cerebral microbleeds in a general Japanese elderly community

We thank Yubi et al.1 for their study, which reports an intriguing result—a significant association between hypertension and lobar cerebral microbleeds (CMBs). Our concern is as follows: hypertensive arteriopathy is generally associated with nonlobar CMBs.2,3 Systemic hypertension is also thought to have a role in the pathology of mixed (lobar and deep/infratentorial) CMBs.2 Furthermore, current knowledge suggests that hypertension concurrently with cerebral amyloid angiopathy (CAA) synergistically contributes to lobar CMB development.4 However, it is unclear in this prospective cohort1 if the significant association of hypertension with lobar microbleeds is in fact with inclusive lobar microbleeds (those with both lobar and nonlobar CMBs) or exclusive lobar microbleeds (only lobar without nonlobar CMBs). If the former, then it is possible that the association is merely a statistical contribution of the deep/infratentorial CMBs included in the group, also taking into consideration the mean older age group and the undiagnosed CAA burden in the aging population. If the latter, it sheds light on an exciting new course for future neuropathologic and topographic studies in patients with CMBs.

脑微出血危险因素及其与认知功能的相关性研究 Risk Factors of Cerebral Microbleeds and Its Correlation with Cognitive Impairment

脑微出血危险因素及其与认知功能的相关性研究 Risk Factors of Cerebral Microbleeds and Its Correlation with Cognitive Impairment