title: Prevalence of Brain MRI Markers of Hemorrhagic Risk in Patients with Stroke and Atrial Fibrillation.
abstract: OBJECTIVE
  Cerebral microbleeds (CMBs), cortical superficial siderosis, white matter lesions (WML), and cerebral atrophy may signify greater bleeding risk particularly in patients in whom anticoagulation is to be considered. We investigated their prevalence and associations with stroke type in patients with stroke and atrial fibrillation (AF).
  
  
  METHODS
  Cross-sectional sample, Monash Medical Centre (Melbourne, Australia) between 2010 and 2013, with brain MRI. MRI abnormalities were rated using standardized methods. Logistic regression was used to study associations adjusting for age and sex.
  
  
  RESULTS
  There were 170 patients, mean age 78 years (SD 9.8), 154 (90.6%) with ischemic stroke. Prevalence of MRI markers were any microbleed 49%, multiple (≥2) microbleeds 30%, confluent WMLs 18.8%, siderosis 8.9%, severe cerebral atrophy 37.7%. Combinations of the severe manifestations of these markers were much less prevalent (2.9-12.4%). Compared with ischemic stroke, those with hemorrhagic stroke were more likely to have ≥10 microbleeds (OR 5.50 95% CI 1.46-20.77,p= 0.012) and siderosis (OR 6.24, 95% CI 1.74-22.40,p= 0.005). Siderosis was associated with multiple microbleeds (OR 8.14, 95% CI 2.38-27.86,p= 0.001). Patients admitted with hemorrhagic stroke and multiple microbleeds were more frequently anticoagulated prior to stroke (6/7, 85.7%) than in those with single (1/2, 50%) or no microbleeds (4/7, 57%).
  
  
  CONCLUSIONS
  Multiple CMBs, severe WML, and severe cerebral atrophy were common individually in hospitalized patients with stroke and AF, but less so in combination. A higher burden of CMBs may be associated with intracerebral hemorrhage in stroke patients with AF.
authors.affiliation: Department of Medicine, Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University , Melbourne, VIC , Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Karayiannis
authors.affiliation: Neuroradiology Service, Monash Imaging, Monash Health , Melbourne, VIC , Australia.
authors.forename: Cathy
authors.initials: C
authors.lastname: Soufan
authors.affiliation: Department of Medicine, Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Neuroradiology Service, Monash Imaging, Monash Health, Melbourne, VIC, Australia.
authors.forename: Ronil V
authors.initials: RV
authors.lastname: Chandra
authors.affiliation: Department of Medicine, Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Stroke Unit, Neurosciences, Monash Health, Melbourne, VIC, Australia.
authors.forename: Thanh G
authors.initials: TG
authors.lastname: Phan
authors.affiliation: Department of Medicine, Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University , Melbourne, VIC , Australia.
authors.forename: Kitty
authors.initials: K
authors.lastname: Wong
authors.affiliation: Department of Medicine, Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Stroke Unit, Neurosciences, Monash Health, Melbourne, VIC, Australia.
authors.forename: Shaloo
authors.initials: S
authors.lastname: Singhal
authors.affiliation: Neuroradiology Service, Monash Imaging, Monash Health , Melbourne, VIC , Australia.
authors.forename: Lee-Anne
authors.initials: LA
authors.lastname: Slater
authors.affiliation: Department of Medicine, Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Stroke Unit, Neurosciences, Monash Health, Melbourne, VIC, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Ly
authors.affiliation: Department of Medicine, Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Department of Medicine, Peninsula Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Aged Care, Alfred Health, Melbourne, VIC, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Moran
authors.affiliation: Department of Medicine, Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Stroke Unit, Neurosciences, Monash Health, Melbourne, VIC, Australia; Department of Medicine, Peninsula Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia.
authors.forename: Velandai
authors.initials: V
authors.lastname: Srikanth
keywords: MRI; atrial fibrillation; microbleeds; stroke