Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
J Stroke Cerebrovasc Dis. 2023 Oct;32(10):107332. doi: 10.1016/j.jstrokecerebrovasdis.2023.107332. Epub 2023 Aug 31.
Cerebral microbleeds (CMB) have been observed in patients with critical illness. We sought to examine the frequency of CMB in patients with acute respiratory distress syndrome (ARDS) and association with neurologic complications including acute cerebral ischemia and seizures.
A retrospective review of patients with ARDS from January 2010 to October 2018 was performed. Patients with brain MRIs with susceptibility weighted imaging or gradient echo sequences were included. We compared neurologic complications and intensive care unit outcomes between patients with and without CMB. Cerebral small vessel disease (CSVD) was defined as the presence of CMB, lacunar infarcts, enlarged perivascular spaces, and white matter hyperintensities.
Of 678 patients with ARDS, 61 met inclusion criteria. Median age was 54 years (IQR 42-63) and 28 were males. Of 12 (20%) with CMB, 10 had lobar CMB. Four patients had CMB in the corpus callosum, all involving the splenium. Neurologic complications were more common in those with CMB including acute cerebral ischemia (41.7% versus 10.2%, p=0.008) and seizures (33.3% versus 8.2%, p=0.021). ARDS rescue therapies were more commonly used in patients with CMB (p=0.005). There was no difference in hospital mortality (41.7% versus 34.7%, p=0.652). Patients with CMB did not have a higher CSVD score than those without CMB when accounting for the presence of CMB (median=1 versus 0, p=0.891).
CMB were present in twenty percent of patients with ARDS who had MRI and were more commonly seen in patients requiring ARDS rescue therapies.
危重病患者中可观察到脑微出血（CMB）。我们旨在研究急性呼吸窘迫综合征（ARDS）患者中 CMB 的发生率，并探讨其与包括急性脑缺血和癫痫发作在内的神经并发症之间的关联。
回顾性分析了 2010 年 1 月至 2018 年 10 月期间患有 ARDS 的患者。纳入了具有磁敏感加权成像或梯度回波序列脑部 MRI 的患者。我们比较了 CMB 患者与无 CMB 患者之间的神经并发症和重症监护病房结局。脑小血管疾病（CSVD）定义为存在 CMB、腔隙性梗死、扩大的血管周围间隙和脑白质高信号。
在 678 例 ARDS 患者中，有 61 例符合纳入标准。中位年龄为 54 岁（IQR 42-63），28 例为男性。在 12 例（20%）有 CMB 的患者中，有 10 例为脑叶 CMB。4 例患者的胼胝体有 CMB，均累及胼胝体压部。有 CMB 的患者更常见神经并发症，包括急性脑缺血（41.7% vs 10.2%，p=0.008）和癫痫发作（33.3% vs 8.2%，p=0.021）。有 CMB 的患者更常使用 ARDS 抢救治疗（p=0.005）。但 CMB 患者的院内死亡率与无 CMB 患者无差异（41.7% vs 34.7%，p=0.652）。当考虑 CMB 的存在时，有 CMB 的患者 CSVD 评分并不高于无 CMB 的患者（中位数=1 与 0，p=0.891）。
在进行 MRI 检查的 ARDS 患者中，有 20%存在 CMB，且更常见于需要 ARDS 抢救治疗的患者。
