Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Neurol India. 2020 Sep-Oct;68(5):1139-1143. doi: 10.4103/0028-3886.299147.
Cerebral microbleed (CMB) is a novel neuroimaging marker of cerebral small vessel disease.
To determine the prevalence of CMB in the subtypes of acute ischemic minor stroke (AIS) and transient ischemic attack (TIA) and to identify the risk factors associated with location and number of CMB.
Patients with AIS (National Institute of Health Stroke Scale of 5 or less) or TIA were included. CMB was characterized using the Microbleed Anatomical Rating Scale (MARS).
Of the 488 subjects [mean age (standard deviation): 57.5 years (14.4 years), males (77.7%)] recruited, CMB was noted in 140 (28.7%). About 35% with CMB had a lacunar stroke etiology, whereas LAA and CE subtype constituted 33.6 and 10.7%, respectively (P = 0.000). Lacunar subtype was more likely to harbor multiple CMB (four or more) and CMB in all locations (lobar, deep or infratentorial). On multivariate analysis, systemic hypertension [P = 0.025; odds ratio (OR) 0.33 (95% confidence interval (CI) 0.129-0.874)], serum triglyceride (TG) levels below 150 mg/dL [P = 0.001; OR 3.70 (95% CI 1.698-8.072)], and presence of white matter hyperintensities on magnetic resonance imaging brain [P = 0.026; OR 2.18 (95% CI 1.096-4.337)] were associated with the presence of CMB. Those with serum TG levels of less than 150 mg/dL were more likely to harbor lobar (P = 0.002) or infratentorial CMB (P = 0.022), whereas those with serum creatinine levels of more than1.5 mg/dL have lobar CMB (P = 0.033).
Our study showed a differential distribution of CMB in ischemic stroke subtypes and association of risk factors with the presence, number and location of CMB.
脑微出血（CMB）是一种新型的脑小血管疾病的神经影像学标志物。
确定急性缺血性小卒中（AIS）和短暂性脑缺血发作（TIA）亚型中 CMB 的患病率，并确定与 CMB 位置和数量相关的危险因素。
纳入 AIS（国立卫生研究院卒中量表评分为 5 或以下）或 TIA 患者。使用微出血解剖评分量表（MARS）对 CMB 进行特征描述。
在纳入的 488 名受试者中[平均年龄（标准差）：57.5 岁（14.4 岁），男性占 77.7%]，140 名（28.7%）存在 CMB。约 35%的 CMB 患者有腔隙性卒中病因，而 LAA 和 CE 亚型分别占 33.6%和 10.7%（P=0.000）。腔隙性亚型更可能存在多个 CMB（4 个或更多）和所有部位（脑叶、深部或幕下）的 CMB。多变量分析显示，全身性高血压（P=0.025；优势比（OR）0.33（95%置信区间（CI）0.129-0.874））、血清三酰甘油（TG）水平低于 150mg/dL（P=0.001；OR 3.70（95%CI 1.698-8.072））和磁共振成像脑白质高信号的存在（P=0.026；OR 2.18（95%CI 1.096-4.337））与 CMB 的存在相关。血清 TG 水平低于 150mg/dL 的患者更可能存在脑叶（P=0.002）或幕下 CMB（P=0.022），而血清肌酐水平高于 1.5mg/dL 的患者则存在脑叶 CMB（P=0.033）。
本研究显示 CMB 在缺血性卒中亚型中的分布存在差异，且危险因素与 CMB 的存在、数量和位置相关。
