Wenz Holger, Wenz Ralf, Maros Máté, Ehrlich Gregory, Al-Zghloul Mansour, Groden Christoph, Förster Alex
From the University Medical Center Mannheim, Department of Neuroradiology (H.W., R.W., M.M., M.A.-Z., C.G., A.F.) and Department of Neurosurgery (G.E.), University of Heidelberg, Mannheim, Germany.
Stroke. 2017 Feb;48(2):307-313. doi: 10.1161/STROKEAHA.116.014335. Epub 2017 Jan 6.
Cerebral microbleeds (cMBs) have previously been linked with especially high incidence in Asian patients with moyamoya together with high tendency to bleed. This, presumably, is characteristic of patients with moyamoya. Herein, we, therefore, investigate retrospectively the frequency, location, and longitudinal course of cMBs in a large German cohort.
We included all patients with moyamoya who underwent standard magnetic resonance imaging, including T2*-weighted images, in our department between 1998 and 2015. Two independent readers evaluated magnetic resonance imaging scans to determine the occurrence of cMBs according to the Brain Observer Microbleed Scale. Demographics, initial symptoms leading to hospitalization, and associated diseases were obtained by chart review.
Overall, there was a total of 242 T2* studies of 101 included moyamoya patients available with a strong female predominance (69.3%). Eight patients (7.9%) were ≤18 years of age. We detected 25 cMBs within 13 patients (12.9%). One patient <18 of age was presented with a cMB; 2 of 3 patients with an intracranial hemorrhage as initial event demonstrated cMB(s). In 72 of 101 cases, there were 1719 person months of follow-up, with 3 adult patients showing 3 de novo cMBs in the course. The majority of cMBs (64.0%) were located at the cortex/gray-white junction.
Although the frequency of cMBs herein is much higher than the expected age-specific incidence, it is still much lower compared with previous reports on cMBs in moyamoya patients of Asian descent. These results might reflect another ethnic-specific difference in patients diagnosed with moyamoya.
此前有研究表明，烟雾病亚洲患者的脑微出血（cMBs）发生率尤其高，且出血倾向也高。这可能是烟雾病患者的特征。因此，我们回顾性研究了一个大型德国队列中cMBs的发生频率、位置及纵向病程。
纳入1998年至2015年间在我院接受包括T2*加权成像在内的标准磁共振成像检查的所有烟雾病患者。两名独立阅片者根据脑微出血观察量表评估磁共振成像扫描结果，以确定cMBs的发生情况。通过查阅病历获取患者的人口统计学信息、导致住院的初始症状及相关疾病。
总体而言，对101例纳入研究的烟雾病患者共进行了242次T2*检查，女性占主导（69.3%）。8例患者（7.9%）年龄≤18岁。我们在13例患者（12.9%）中检测到25处cMBs。1例年龄<18岁的患者出现cMB；3例以颅内出血为初始事件的患者中有2例出现cMB。在101例患者中的72例中，有1719人月的随访期，3例成年患者在病程中出现3处新发cMBs。大多数cMBs（64.0%）位于皮质/灰白质交界处。
尽管本研究中cMBs的发生率远高于预期的年龄特异性发生率，但与之前关于亚裔烟雾病患者cMBs的报道相比仍低得多。这些结果可能反映了烟雾病患者中另一种种族特异性差异。
