title: Cerebral microbleeds predict impending intracranial hemorrhage in infective endocarditis.
abstract: BACKGROUND
  Cerebral microbleeds (CMBs) detected by T2*-weighted MRI are a potential indicator of hypertension, microvascular disease and hemorrhagic stroke. An association between infective endocarditis (IE) and CMBs has been reported recently, but the clinical significance remains unclear. We hypothesized that CMBs in patients with IE are associated with vascular vulnerabilities such as mycotic aneurysm or pyogenic vasculitis.
  
  
  METHODS
  We retrospectively reviewed 26 consecutive patients with definite IE who underwent T2*-weighted MRI and were admitted to 2 medical centers in Osaka, Japan, between January 2006 and June 2010. We examined the incidence of symptomatic intracranial hemorrhage (ICH) occurring after initial MRI examination and investigated the association between ICH, CMBs and other clinical characteristics.
  
  
  RESULTS
  CMBs were identified in 14 patients (54%), and 72% of CMBs were found in the lobar region. Symptomatic ICH was observed in 8 patients (31%) during the 3-month follow-up period after initial MRI examination. In multiple logistic regression analyses, the presence of preceding ICH [odds ratio (OR) 40.0, 95% confidence interval (CI) 2.5-2,870] and the presence of CMBs (OR 34.0, 95% CI 1.3-17,300) were independent predictors of the development of ICH. Using cutoff values for CMBs of ≥2 and ≥3, the adjusted ORs for ICH increased (OR 42.1, 95% CI 1.9-24,300, and OR 70.1, 95% CI 2.5-105,000, respectively).
  
  
  CONCLUSIONS
  In addition to prior ICH, the presence of CMBs was a strong predictor of impending ICH in patients with IE. CMBs might represent vascular vulnerability related to IE.
authors: Department of Neurology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. s-okazaki@umin.ac.jp
authors: Shuhei
authors: S
authors: Okazaki
authors: Manabu
authors: M
authors: Sakaguchi
authors: BooHan
authors: B
authors: Hyun
authors: Keiko
authors: K
authors: Nagano
authors: Masafumi
authors: M
authors: Tagaya
authors: Yasushi
authors: Y
authors: Sakata
authors: Taichi
authors: T
authors: Sakaguchi
authors: Kazuo
authors: K
authors: Kitagawa
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000473:pathology; D059345:Cerebral Small Vessel Diseases / Q000175:diagnosis* / Q000473:pathology; D004696:Endocarditis / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000453:epidemiology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors