Department of Neurology, Vesalius Research Center, University Hospitals, Herestraat 49, B3000 Leuven, Belgium.
Stroke. 2010 Sep;41(9):2005-9. doi: 10.1161/STROKEAHA.110.588020. Epub 2010 Jul 22.
We studied the risk of recurrent cerebrovascular events in patients who had a transient ischemic attack or ischemic stroke and who had evidence of microbleeds on MRI.
A prospective follow-up study was performed on hospitalized patients who were at least 50 years old with a transient ischemic attack or an ischemic stroke. The presence and number of microbleeds were assessed on gradient echo MRI and the presence of white matter disease on fluid-attenuated inversion recovery imaging using a semiquantitative scale. Patients were followed up by phone every 6 months. End points were intracerebral hemorrhage, ischemic stroke, and unclassified stroke. Cerebral events were adjudicated by 2 independent neurologists blinded to the presence of microbleeds. Cox regression analysis was performed.
A total of 487 patients with a mean age of 72 years were followed up for a median of 2.2 years (25th to 75th percentile 1.9 to 2.7 years). Microbleeds were identified in 129 patients (25.6%). Two patients developed intracerebral hemorrhage during follow-up, 32 patients developed recurrent ischemic stroke, and 3 patients had unclassified strokes. Microbleeds were not independent predictors of recurrent stroke (P=0.2) or intracerebral hemorrhage (P=0.43). Lobar microbleeds or combined lobar and deep microbleeds were independently associated with recurrent stroke (P=0.018).
In this European cohort, patients with microbleeds who have had cerebral ischemia have a higher risk of developing new ischemic strokes than of intracerebral hemorrhage. Lobar microbleeds or combined lobar and deep microbleeds might be independent predictors of recurrent stroke.
我们研究了磁共振成像（MRI）显示存在微出血的短暂性脑缺血发作或缺血性卒中患者发生复发性脑血管事件的风险。
对至少 50 岁的因短暂性脑缺血发作或缺血性卒住院的患者进行前瞻性随访研究。采用梯度回波 MRI 评估微出血的存在和数量，并采用半定量评分法对液体衰减反转恢复成像上的脑白质疾病的存在进行评估。通过电话每 6 个月对患者进行随访。终点事件为脑出血、缺血性卒中和未分类卒。由 2 位独立的神经科医生对微出血的存在进行盲法判断，并对脑卒事件进行裁决。采用 Cox 回归分析。
共纳入 487 例平均年龄为 72 岁的患者，中位随访时间为 2.2 年（25 分位至 75 分位 1.9 至 2.7 年）。129 例（25.6%）患者发现微出血。2 例患者在随访期间发生脑出血，32 例患者发生复发性缺血性卒，3 例患者发生未分类卒。微出血与复发性卒（P=0.2）或脑出血（P=0.43）无关。脑叶微出血或脑叶和深部微出血联合与复发性卒有关（P=0.018）。
在这项欧洲队列研究中，发生脑缺血的微出血患者发生新发缺血性卒的风险高于脑出血。脑叶微出血或脑叶和深部微出血联合可能是复发性卒的独立预测因子。
