Microbleeds and the risk of recurrent stroke.
OBJECTIVE
We studied the risk of recurrent cerebrovascular events in patients who had a transient ischemic attack or ischemic stroke and who had evidence of microbleeds on MRI.


METHODS
A prospective follow-up study was performed on hospitalized patients who were at least 50 years old with a transient ischemic attack or an ischemic stroke. The presence and number of microbleeds were assessed on gradient echo MRI and the presence of white matter disease on fluid-attenuated inversion recovery imaging using a semiquantitative scale. Patients were followed up by phone every 6 months. End points were intracerebral hemorrhage, ischemic stroke, and unclassified stroke. Cerebral events were adjudicated by 2 independent neurologists blinded to the presence of microbleeds. Cox regression analysis was performed.


RESULTS
A total of 487 patients with a mean age of 72 years were followed up for a median of 2.2 years (25th to 75th percentile 1.9 to 2.7 years). Microbleeds were identified in 129 patients (25.6%). Two patients developed intracerebral hemorrhage during follow-up, 32 patients developed recurrent ischemic stroke, and 3 patients had unclassified strokes. Microbleeds were not independent predictors of recurrent stroke (P=0.2) or intracerebral hemorrhage (P=0.43). Lobar microbleeds or combined lobar and deep microbleeds were independently associated with recurrent stroke (P=0.018).


CONCLUSIONS
In this European cohort, patients with microbleeds who have had cerebral ischemia have a higher risk of developing new ischemic strokes than of intracerebral hemorrhage. Lobar microbleeds or combined lobar and deep microbleeds might be independent predictors of recurrent stroke.
Thijs
Vincent
V
Department of Neurology, Vesalius Research Center, University Hospitals, Herestraat 49, B3000 Leuven, Belgium. vincent.thijs@uz.kuleuven.ac.be
Lemmens
Robin
R
Schoofs
Christophe
C
Görner
Astrid
A
Van Damme
Philip
P
Schrooten
Maarten
M
Demaerel
Philippe
P
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications* / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000503:physiopathology