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Cerebral Microbleeds Are Associated With an Increased Risk of Stroke: The Rotterdam Study

Saloua Akoudad1, Marileen L P Portegies1, Peter J Koudstaal1

  • 1From Departments of Epidemiology (S.A., M.L.P.P., A.H., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), and Neurology (S.A., M.L.P.P., P.J.K., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.

Circulation
|July 4, 2015
PubMed
Abstract

Insights

Cerebral microbleeds detected by MRI are linked to a higher risk of stroke in the general population. These findings suggest microbleeds indicate worsening cerebrovascular disease and may precede stroke events.

Area of Science:

  • Neurology
  • Radiology
  • Epidemiology

Background:

  • Cerebral microbleeds are common in cerebrovascular disease and predict stroke recurrence.
  • Their clinical significance in healthy elderly individuals remains unclear.

Purpose of the Study:

  • To investigate the association between cerebral microbleeds and incident stroke risk in the general population.
  • To determine if microbleed characteristics (presence, number, location) modify stroke risk.

Main Methods:

  • Population-based Rotterdam Study with 4759 participants (aged ≥45 years).
  • Brain MRI assessed microbleeds at baseline; participants followed for stroke (2005-2013).
  • Cox proportional hazards models adjusted for confounders.

Main Results:

  • Microbleed prevalence was 18.7%; 93 strokes occurred during follow-up.
  • Microbleed presence associated with a 1.93-fold increased risk of all strokes.
  • Lobar microbleeds linked to a 5.27-fold increased risk of intracerebral hemorrhage; other locations increased risk for both ischemic and hemorrhagic stroke.

Conclusions:

  • Cerebral microbleeds on MRI are an independent marker of increased stroke risk in the general population.
  • Microbleeds likely represent advancing cerebrovascular pathology and serve as a stroke precursor.
Keywords:
cerebral microbleedsepidemiologyhemorrhagemagnetic resonance imagingstroke

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