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Difference in the Location and Risk Factors of Cerebral Microbleeds According to Ischemic Stroke Subtypes
Bum Joon Kim1, Youngshin Yoon2, Hoyon Sohn2
1Department of Neurology, Kyung Hee University Hospital, Seoul, Korea.
Background And Purpose:
The location of cerebral microbleeds (CMBs) may differ according to ischemic stroke subtype, and the underlying pathomechanism may differ by their location. Here, we investigated the characteristics of CMBs according to various ischemic stroke subtypes to verify this issue.
Methods:
Patients with acute ischemic stroke were consecutively included. The presence of CMBs was determined by gradient echo image sequence. The distribution of CMBs was classified as deep, lobar, or diffuse (both deep and lobar). The prevalence, risk factors, and distribution of CMBs were compared among patients with different stroke subtypes. Factors associated with the distribution of CMBs were investigated.
Results:
Among the 1033 patients included in this study, ischemic stroke subtypes were classified as large artery atherosclerosis (LAA; n=432), small vessel occlusion (SVO; n=304), and cardioembolism (CE; n=297). The prevalence of CMBs was highest in patients with SVO (40.5%), followed by CE (33.0%) and LAA (24.8%; P<0.001). The locations of CMBs was different according to subtype (P=0.004). CE [odds ratio (OR)=1.85 (1.02-3.34); P=0.042] and the use of antithrombotics [OR=1.80 (1.10-2.94); P=0.019] were associated with lobar CMBs, and old age [OR=1.02 (1.00-1.04); P=0.015] and hypertension [OR=1.61 (1.08-2.40); P=0.020] were associated with deep CMBs.
Conclusions:
CMBs were frequently located in the lobar area in patients with CE. Previous use of antithrombotic agents is associated with lobar CMBs. The pathogenic mechanism of CMB may differ according to ischemic stroke subtype and location.
Insights
Cerebral microbleeds (CMBs) prevalence and location vary by ischemic stroke subtype. Cardioembolism (CE) is linked to lobar CMBs, while small vessel occlusion (SVO) shows the highest CMB prevalence.
Area of Science:
- Neurology
- Radiology
- Stroke Research
Background:
- Cerebral microbleeds (CMBs) are associated with various neurological conditions.
- The location of CMBs may provide insights into underlying pathomechanisms.
- Investigating CMB characteristics across different ischemic stroke subtypes is crucial.
Purpose of the Study:
- To investigate the characteristics of cerebral microbleeds (CMBs) in relation to different ischemic stroke subtypes.
- To determine if CMB location differs based on stroke etiology.
- To explore potential differences in pathomechanisms underlying CMBs.
Main Methods:
- Consecutive inclusion of patients with acute ischemic stroke.
- Gradient echo imaging sequence used for CMB detection.
- Classification of CMB distribution into deep, lobar, or diffuse categories.
- Comparison of CMB prevalence, risk factors, and distribution across stroke subtypes (large artery atherosclerosis, small vessel occlusion, cardioembolism).
Main Results:
- Out of 1033 patients, CMB prevalence was highest in small vessel occlusion (SVO; 40.5%), followed by cardioembolism (CE; 33.0%), and large artery atherosclerosis (LAA; 24.8%).
- CMB location significantly differed by stroke subtype (P=0.004).
- Cardioembolism (CE) and antithrombotic use were associated with lobar CMBs. Old age and hypertension were associated with deep CMBs.
Conclusions:
- Cerebral microbleeds (CMBs) are frequently observed in the lobar region for patients with cardioembolism (CE).
- Antithrombotic agent use is a significant factor associated with lobar CMBs.
- The pathogenic mechanisms of CMBs likely vary depending on the ischemic stroke subtype and the location of the microbleeds.
