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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
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Clinical characteristics by topographical distribution of brain microbleeds, with a particular emphasis on diffuse

Yusuke Yakushiji1, Chiaki Yokota, Naoaki Yamada

  • 1Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan. yakushij@cc.saga-med.ac.jp

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|July 13, 2010
PubMed

Insights

Diffuse brain microbleeds (MBs) are linked to hypertensive stroke, high blood pressure, and severe white matter hyperintensity (WMH). This suggests microangiopathy in hypertensive arteriopathy and cerebral amyloid angiopathy may cause diffuse MBs.

Area of Science:

  • Neurology
  • Neuroradiology
  • Vascular Neurology

Background:

  • Brain microbleeds (MBs) are topographical, categorized as lobar or deep/infratentorial.
  • Diffuse MBs occur in both lobar and deep/infratentorial areas.
  • Understanding the clinical features of diffuse MBs is crucial for elucidating primary intracerebral hemorrhage (pICH) pathogenesis.

Purpose of the Study:

  • To investigate the clinical features, including ambulatory blood pressure (ABP), of patients with diffuse MBs.
  • To explore the association between diffuse MBs and stroke subtypes, blood pressure, and white matter hyperintensity (WMH).

Main Methods:

  • Prospective enrollment of 124 patients with first-ever acute stroke.
  • Gradient-echo T2*-weighted magnetic resonance imaging (MRI) using a 1.5-T scanner.
  • Classification into MBs-negative, lobar, deep/infratentorial, and diffuse MBs groups.

Main Results:

  • MB distribution varied significantly across stroke subtypes (P=.004), with pICH showing the highest prevalence of diffuse MBs (35%).
  • The diffuse MBs group exhibited the highest severity of white matter hyperintensity (WMH) (P < .0001).
  • Elevated casual blood pressure (CBP) and ABP were observed in deep and diffuse MBs groups compared to the MBs-negative group.

Conclusions:

  • Diffuse MBs are associated with hypertensive stroke, elevated blood pressure, and severe WMH.
  • The pathogenesis of diffuse MBs may involve more severe microangiopathy, characteristic of hypertensive arteriopathy and cerebral amyloid angiopathy.

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