title: Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis.
abstract: BACKGROUND
  Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH.
  
  
  METHODS
  In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death.
  
  
  RESULTS
  Of 672 patients with IVT (mean age 62 ± 14 years, 52% men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8% versus 3.5%; P = .27). However, sICH occurred more frequently (P = .0009) in patients with > 10 CMBs (30%, 95% confidence interval [CI] by the adjusted Wald method: 10%-61%). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently (P = .0004) associated with a higher likelihood for sICH (odds ratio [OR]:13.4, 95%CI:3.2-55.9).
  
  
  CONCLUSIONS
  Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present.
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia. Electronic address: rzand@UTHSC.edu.
authors.forename: Ramin
authors.initials: R
authors.lastname: Zand
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Mantinderpreet
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Michael
authors.initials: M
authors.lastname: McCormack
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Nitin
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Muhammad Fawad
authors.initials: MF
authors.lastname: Ishfaq
authors.affiliation: Department of Neurology, University of Alabama, Birmingham, Alabama.
authors.forename: Reza Bavarsad
authors.initials: RB
authors.lastname: Shahripour
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Katherine
authors.initials: K
authors.lastname: Nearing
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Lucas
authors.initials: L
authors.lastname: Elijovich
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.affiliation: Department of Neurology, University of California, Los Angeles, California.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D061605:Administration, Intravenous / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Brain microbleeds; CT scan; MRI; intracerebral hemorrhage; ischemic stroke; thrombolysis