title: Asymptomatic cerebral microbleeds in adult patients with moyamoya disease: a prospective cohort study with 2 years of follow-up.
abstract: OBJECTIVE
  Risk factors for cerebral microbleeds (CMBs) in moyamoya disease (MMD) remain unknown, and whether the presence or distribution of CMBs is related to the subsequent hemorrhagic events needs to be confirmed. This study aimed to investigate the relationship between intracranial vascular morphology and the incidence/distribution patterns of CMBs as well as to determine the outcome in adult patients with MMD.
  
  
  METHODS
  Eighty-five consecutive adult patients with MMD were prospectively evaluated by 3.0-tesla high-intensity susceptibility-weighted magnetic resonance imaging and catheter-based digital subtraction angiography from June 2009 to January 2012. The differences in intracranial angiography (Suzuki stages, posterior cerebral artery stages, and angiographic features of the anterior choroidal and posterior communicating arteries) and clinical parameters (age, gender, hemorrhagic onset, antiplatelet treatment, systolic/diastolic blood pressure, diabetes, and plasma fibrinogen) among various CMB distribution patterns were analyzed with multinomial logistic regression. Moreover, after a median follow-up of 23 months, the relationship between CMB distribution patterns and subsequent intraventricular hemorrhage was also analyzed with Kaplan-Meier survival analysis and a Cox proportional hazards model.
  
  
  RESULTS
  Forty-five female and 40 male patients were finally enrolled in the study with an average age of 41.4 ± 12.7 years. Thirty-one CMB foci were detected in 24 (28.2%) patients. Most of the lesions (n = 22, 71.0%) were located in the region of deep and periventricular white matter (DPWM). Dilation and extension of anterior choroidal and posterior communicating arteries (AChA-PComA) was found to be an independent risk factor associated with the CMBs located in DPWM (p = 0.045; odds ratio 3.39, 95% CI 1.03-11.19). Patients with DPWM CMBs showed a statistically higher likelihood of subsequent intraventricular hemorrhage compared to patients without CMB foci and with CMBs in other regions (p = 0.014) during the follow-up period. Multivariable analysis suggested that DPWM CMBs were independent predictors of subsequent intraventricular hemorrhage (p = 0.028; hazard ratio 5.53, 95% CI 1.20-25.41).
  
  
  CONCLUSIONS
  Dilation and extension of AChA-PComA is a determinant of CMBs involved in DPWM. CMBs in DPWM are probably predictors of subsequent intraventricular hemorrhage.
authors.affiliation: Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, People's Republic of China.
authors.forename: Wen
authors.initials: W
authors.lastname: Sun
authors.forename: Cuiping
authors.initials: C
authors.lastname: Yuan
authors.forename: Wenhua
authors.initials: W
authors.lastname: Liu
authors.forename: Yongkun
authors.initials: Y
authors.lastname: Li
authors.forename: Zhixin
authors.initials: Z
authors.lastname: Huang
authors.forename: Wusheng
authors.initials: W
authors.lastname: Zhu
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.forename: Gelin
authors.initials: G
authors.lastname: Xu
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D058070:Asymptomatic Diseases; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors