scholarly journals Prevalence of Cerebral Microbleeds in Thai Patients with Ischemic Stroke

2017 ◽  
Vol 08 (02) ◽  
pp. 216-220 ◽  
Author(s):  
Artit Potigumjon ◽  
Arvemas Watcharakorn ◽  
Pornpatr A. Dharmasaroja
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Magnetic Resonance ◽  
White Matter Lesions ◽  
Cerebral Microbleeds ◽  
National Institutes Of Health ◽  
Asian Origin ◽  
Chinese Study ◽  
Japanese Studies ◽  
Magnetic Resonance Imaging Mri

ABSTRACT Background: With the widespread use of magnetic resonance imaging (MRI), cerebral microbleeds (CMBs) are commonly detected. Ethnicity seems to play a role in the prevalence of CMB, with higher prevalence in participants from Asian origin. The purpose of the study is to look for the prevalence of CMBs and associated factors in Thai patients with ischemic stroke. Methods: Patients with acute ischemic stroke who had MRI and magnetic resonance angiography during January–August 2014 were included in the study. T2*-weighted gradient-recalled echo was used to define CMBs. Baseline characteristics, stroke subtypes, and severity of white matter lesions were compared between patients with and without CMBs. Results: Two hundred patients were included in the study. Mean age of the patients was 61-year-old. Mean National Institutes of Health Stroke Scale was 8. The prevalence of CMBs was 20% (39/200 patients). Hypertension (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.07–8.68, P = 0.037), and moderate-to-severe white matter lesions (Fazekas 2–3, OR 7.61, 95% CI 3.06–18.95, P < 0.001) were related to the presence of CMBs. Conclusions: CMBs were found in 20% of patients with ischemic stroke, which was lower than those reported from Japanese studies but comparable to a Chinese study. CMBs were associated with hypertension and severity of the white matter lesions.

scholarly journals Rivaroxaban for Prevention of Covert Brain Infarcts and Cognitive Decline

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 2901-2909
Author(s):  
Mukul Sharma ◽  
Robert G. Hart ◽  
Eric E. Smith ◽  
Jacqueline Bosch ◽  
John W. Eikelboom ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Magnetic Resonance ◽  
Cognitive Decline ◽  
Odds Ratio ◽  
White Matter Hyperintensities ◽  
Cerebral Microbleeds ◽  
Cognitive Tests ◽  
Brain Infarcts ◽  
End Point

Background and Purpose: Covert brain infarcts are associated with cognitive decline. It is not known whether therapies that prevent symptomatic stroke prevent covert infarcts. COMPASS compared rivaroxaban with and without aspirin with aspirin for the prevention of stroke, myocardial infarction, and vascular death in participants with stable vascular disease and was terminated early because of benefits of rivaroxaban 2.5 mg twice daily plus aspirin over aspirin. We obtained serial magnetic resonance imagings and cognitive tests in a consenting subgroup of COMPASS patients to examine treatment effects on infarcts, cerebral microbleeds, and white matter hyperintensities. Methods: Baseline and follow-up magnetic resonance imagings were completed in 1445 participants with a mean (SD) interval of 2.0 (0.7) years. Whole-brain T1, T2 fluid-attenuated inversion recovery, T2* sequences were centrally interpreted by blinded, trained readers. Participants had serial measurements of cognition and function. The primary end point was the proportion of participants with incident covert infarcts. Secondary end points were the composite of clinical stroke and covert brain infarcts, cerebral microbleeds, and white matter hyperintensities. Results: At baseline, 493 (34.1%) participants had infarcts. Incident covert infarcts occurred in 55 (3.8%) participants. In the overall trial rivaroxaban plus aspirin reduced ischemic stroke by 49% (0.7% versus 1.4%; hazard ratio [95% CI], 0.51 [0.38–0.68]). In the magnetic resonance imaging substudy the effects of rivaroxaban+aspirin versus aspirin were: covert infarcts: 2.7% versus 3.5% (odds ratio [95% CI], 0.77 [0.37–1.60]); Covert infarcts or ischemic stroke: 2.9% versus 5.3% (odds ratio [95% CI], 0.53 [0.27–1.03]). Incident microbleeds occurred in 6.6% of participants and 65.7% of participants had an increase in white matter hyperintensities volume with no effect of treatment for either end point. There was no effect on cognitive tests. Conclusions: Covert infarcts were not significantly reduced by treatment with rivaroxaban and aspirin but estimates for the combination of ischemic stroke and covert infarcts were consistent with the effect on ischemic stroke in the overall trial. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01776424.

scholarly journals Phenotypes of Chronic Covert Brain Infarction in Patients With First-Ever Ischemic Stroke: A Cohort Study

Stroke ◽  
2021 ◽  
Author(s):  
Jan Vynckier ◽  
Johannes Kaesmacher ◽  
Joanna Marguerite Wardlaw ◽  
Laurent Roten ◽  
Morin Beyeler ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
White Matter ◽  
Brain Infarction ◽  
White Matter Lesions ◽  
Diagnostic Value ◽  
National Institutes Of Health ◽  
White Matter Hyperintensity ◽  
Vascular Risk ◽  
Scale Scores

Background and Purpose: The aim of this study was to assess the rate of chronic covert brain infarctions (CBIs) in patients with acute ischemic stroke (AIS) and to describe their phenotypes and diagnostic value. Methods: This is a single-center cohort study including 1546 consecutive patients with first-ever AIS on magnetic resonance imaging imaging from January 2015 to December 2017. The main study outcomes were CBI phenotypes, their relative frequencies, location, and association with vascular risk factors. Results: Any CBI was present in 574/1546 (37% [95% CI, 35%–40%]) of patients with a total of 950 CBI lesions. The most frequent locations of CBI were cerebellar in 295/950 (31%), subcortical supratentorial in 292/950 (31%), and cortical in 213/950 (24%). CBI phenotypes included lacunes (49%), combined gray and white matter lesions (30%), gray matter lesions (13%), and large subcortical infarcts (7%). Vascular risk profile and white matter hyperintensities severity (19% if no white matter hyperintensity, 63% in severe white matter hyperintensity, P <0.001) were associated with presence of any CBI. Atrial fibrillation was associated with cortical lesions (adjusted odds ratio, 2.032 [95% CI, 1.041–3.967]). Median National Institutes of Health Stroke Scale scores on admission were higher in patients with an embolic CBI phenotype (median National Institutes of Health Stroke Scale, 5 [2–10], P =0.025). Conclusions: CBIs were present in more than a third of patients with first AIS. Their location and phenotypes as determined by MRI were different from previous studies using computed tomography imaging. Among patients suffering from AIS, those with additional CBI represent a vascular high-risk subgroup and the association of different phenotypes of CBIs with differing risk factor profiles potentially points toward discriminative AIS etiologies.

scholarly journals Prevalence of cerebral microbleeds and other cardiovascular risk factors in elderly patients with acute ischemic stroke

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Abeer Abdelzaher Ibrahim ◽  
Yosra Abdelzaher Ibrahim ◽  
Eman A. Darwish ◽  
Nivan Hany Khater
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
White Matter ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Recurrent Stroke ◽  
White Matter Lesions ◽  
Cerebral Microbleeds ◽  
Amyloid Angiopathy ◽  
Associated Risk Factors

Abstract Background Cerebral microbleeds are small, round dark-signal foci in the T2*-weighted magnetic resonance imaging. They are encountered in cerebral amyloid angiopathy and hypertensive vasculopathy. Their prevalence is common in ischemic stroke and cerebral hemorrhage. The purpose of this study is to investigate the prevalence of CMBs and associated risk factors in the elderly patients with acute ischemic stroke. Results Cerebral microbleeds were significantly associated with the presence of hypertension (in the subgroup of recurrent stroke) and with hypercholesterolemia. There was a significant association between the number of the microbleeds and severity of white matter lesions as a higher number of microbleeds related to more severe white matter lesions. The microbleeds were more prevalent in the group of patients using antithrombotics. Conclusion Age, hypercholesterolemia, and the use of antithrombotics emerged as the most important associated risk factors for the presence of CMBs. On MRI, there was a significant association between the number of CMBs and severity of white matter lesions as a higher number of CMBs related to more severe white matter lesions.

scholarly journals Association of Ambulatory Blood Pressure and Heart Rate With Advanced White Matter Lesions in Ischemic Stroke Patients

2013 ◽  
Vol 27 (2) ◽  
pp. 177-183 ◽  
Author(s):  
Hyuk Sung Kwon ◽  
Young-Hyo Lim ◽  
Hyun Young Kim ◽  
Hee-Tae Kim ◽  
Hyung-Min Kwon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Ischemic Stroke ◽  
White Matter ◽  
Ambulatory Blood Pressure ◽  
White Matter Lesions ◽  
Stroke Patients

scholarly journals ASPREE-NEURO study protocol: A randomized controlled trial to determine the effect of low-dose aspirin on cerebral microbleeds, white matter hyperintensities, cognition, and stroke in the healthy elderly

2016 ◽  
Vol 12 (1) ◽  
pp. 108-113 ◽  
Author(s):  
Stephanie A Ward ◽  
Parnesh Raniga ◽  
Nicholas J Ferris ◽  
Robyn L Woods ◽  
Elsdon Storey ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Primary Prevention ◽  
Magnetic Resonance ◽  
Controlled Trial ◽  
Brain Magnetic Resonance Imaging ◽  
Cerebral Microbleeds ◽  
Resonance Imaging ◽  
Healthy Elderly ◽  
Cerebral Microbleed

Rationale Cerebral microbleeds seen on brain magnetic resonance imaging are markers of small vessel disease, linked to cognitive dysfunction and increased ischemic and hemorrhagic stroke risk. Observational studies suggest that aspirin use may induce cerebral microbleeds, and associated overt intracranial hemorrhage, but this has not been definitively resolved. Aims ASPREE-NEURO will determine the effect of aspirin on cerebral microbleed development over three years in healthy adults aged 70 years and over, participating in the larger ‘ASPirin in Reducing Events in the Elderly (ASPREE)’ primary prevention study of aspirin. Sample size Five hundred and fifty-nine participants provide 75% power (two-sided p value of 0.05) to determine an average difference of 0.5 cerebral microbleed per person after three years. Methods and design A multi-center, randomized placebo-controlled trial of 100 mg daily aspirin in participants who have brain magnetic resonance imaging at study entry, one and three years after randomization and who undergo cognitive testing at the same time points. Study outcomes The primary outcome is the number of new cerebral microbleeds on magnetic resonance imaging after three years. Secondary outcomes are the number of new cerebral microbleeds after one year, change in volume of white matter hyperintensity, cognitive function, and stroke. Discussion ASPREE-NEURO will resolve whether aspirin affects the presence and number of cerebral microbleeds, their relationship with cognitive performance, and indicate whether consideration of cerebral microbleeds alters the risk-benefit profile of aspirin in primary prevention for older people. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613001313729.

Magnetic resonance imaging cinecisternography in patients with white matter lesions

1992 ◽  
Vol 2 (4) ◽  
pp. 213-215
Author(s):  
Yasuo Fukuuchi ◽  
Takahiro Amano ◽  
Hayao Shiga ◽  
Makoto Ichijo ◽  
Yoshiaki Itoh ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
White Matter Lesions ◽  
Resonance Imaging

scholarly journals Leukoencephalopathy with brainstem and spinal cord involvement and high brain lactate: report of three brazilian patients

2007 ◽  
Vol 65 (2b) ◽  
pp. 506-511 ◽  
Author(s):  
Daniel Gurgel Fernandes Távora ◽  
Mauro Nakayama ◽  
Rômulo Lopes Gama ◽  
Thereza Cristina de Lara Alvim ◽  
Dalton Portugal ◽  
...  
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Magnetic Resonance ◽  
Autosomal Recessive Disorder ◽  
Dorsal Column ◽  
Resonance Spectroscopy ◽  
Motor Neuropathy ◽  
Spinal Cord Involvement ◽  
Spinal Cord Dorsal ◽  
Magnetic Resonance Imaging Mri

A novel leukoencephalopathy was recently identified based on magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (¹H-MRS) findings. Leukoencephalopathy with brainstem and spinal cord involvement and high lactate (LBSL) is an autosomal recessive disorder characterized by early onset of symptoms and slowly progressive cerebellar, pyramidal and spinal cord dorsal column dysfunction. MRI and ¹H-MRS typically show abnormalities within cerebral and cerebellar white matter, a characteristic involvement of brainstem and spinal cord tracts and elevated lactate in the abnormal white matter. We present three cases with characteristic clinical and neuroimaging findings of this disorder. Some additional unique findings of our patients are discussed, like distal motor neuropathy and elevated creatine kinase in the serum.

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