Does microbleed predict haemorrhagic transformation after acute atherothrombotic or cardioembolic stroke?

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 79; no. 8; pp. 913 - 916
• Main Authors: Lee, S-H, Kang, B-S, Kim, N, Roh, J-K
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.08.2008; BMJ; BMJ Publishing Group LTD
• Subjects: Aged; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Atherosclerosis - complications; Atherosclerosis - drug therapy; Biological and medical sciences; Blood clots; Blood pressure; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - diagnosis; Cerebral Infarction - diagnosis; Cerebral Infarction - drug therapy; Cholesterol; Diabetes; Embolism - complications; Embolism - drug therapy; Female; Glucose; Heart Diseases - complications; Heart Diseases - drug therapy; Humans; Hypertension; Intracranial Embolism - diagnosis; Intracranial Embolism - drug therapy; Ischemia; Ischemic Attack, Transient - complications; Ischemic Attack, Transient - drug therapy; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neurology; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Risk Factors; Stroke; Thrombolytic Therapy; Transient ischemic attack; Vascular diseases and vascular malformations of the nervous system; Veins & arteries; Vascular disease; Stroke; Nervous system diseases; Central nervous system disease; Cardiovascular disease; Hemorrhage; Thrombosis; Cerebrovascular disease; Cerebral disorder
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2007.133876

Objectives: Cerebral microbleeds (MBs) are known to be indicative of bleeding-prone microangiopathy and may predict incident intracerebral haemorrhage. However, there is controversy concerning the causal relationship between the presence of MBs and haemorrhagic transformation (HTf) after ischaemic stroke. Methods: Of the 1034 patients with acute ischaemic stroke who were consecutively admitted to our hospital, 377 patients with stroke due to large-artery atherothrombosis or cardioembolism were selected for participation in this study. We examined the MBs using T2*-weighted gradient-echo MRI performed within 24 hours after admission, and the incidence of HTf was assessed using follow-up brain MRI during the hospitalisation period. Results: Of the 377 patients with stroke, 234 were male (62.1%) and the mean age was 66.2 ±11.7 years. MBs were initially found in 109 patients (28.9%), and newly incident HTf was noted during the hospitalisation period in 74 patients (19.6%). The presence of MBs was not increased in the patients with HTf (24.3% vs. 30.0% in the patients without HTf; p = 0.331). In addition, the number of MBs was not higher in the patients with HTf (0.7±1.5 vs. 1.8±8.1; p = 0.234). This lack of significance between MBs and HTf persisted after stratification by stroke mechanism. Conclusions: This study suggests that underlying MBs do not predict incident HTf after acute ischaemic stroke. The clinical significance of MBs should be differentially evaluated according to the type of disease (intracerebral haemorrhage vs. HTf).