Petrie Benjamin K, Lau Helena, Cajiga-Pena Fe Maria, Abbas Saleh, Finn Brandon, Dam Katie, Cervantes-Arslanian Anna M, Nguyen Thanh N, Aparicio Hugo J, Greer David, Romero Jose Rafael
Department of Neurology, School of Medicine, Medical Campus, Boston University, Boston, MA, USA.
McGaw Medical Center, Northwestern University, Chicago, MN, USA.
Int J Stroke. 2025 Aug;20(7):874-882. doi: 10.1177/17474930251328524. Epub 2025 Mar 11.
Cerebral microbleeds (CMB) signal cerebral small vessel disease and are associated with ischemic stroke. While illicit drug use (IDU) is linked to cerebral vasculopathy, the association between CMB and IDU is poorly characterized.
Our primary aim was to explore the relationship between IDU and CMB and delineate differences in vascular risk factors between those with and without CMB.
We included 1746 (1614 unique patients) acute ischemic stroke and transient ischemic accident patient admissions from 2009 to 2018 with a readable T2*gradient-echo sequence brain magnetic resonance imaging (MRI). We retrospectively obtained patient characteristics and IDU data (by history and/or urine toxicology). MRIs were reviewed for CMB and classified topographically as lobar, deep, or infratentorial. Univariate analysis was used to assess differences in patient characteristics between those with and without CMB, as well as variation in CMB location by drug category subgrouping. Coprimary multivariate logistic/Poisson regression was used to characterize the association between drug category subgrouping and CMB.
We observed IDU in 13.8% (n = 241) and CMB presence in 32.9% (n = 575) in our predominantly black, middle-aged population. 53.8% of CMB were lobar, 27.3% were deep, and 18.8% were infratentorial. Within the IDU group, those with at least one CMB (compared to those without CMB) were older (56.9 ± 11.5 vs 53.6 ± 10.5, p = 0.036), had a lower body mass index (26.6 ± 4.4 vs 28.1 ± 5.9, p = 0.039), and were more likely to have chronic kidney disease (9.5% vs 3.0%, p = 0.033) or have had a previous ischemic stroke/transient ischemic attack (41.9% vs 25.1%, p = 0.009). On coprimary analysis, cocaine use was associated with increased CMB number by 0.24 (95% confidence interval (CI): 0.09, 0.38; p = 0.001) and opioid use was associated with increased CMB number by 0.31 (95% CI: 0.08, 0.52; p < 0.001) controlling for age, sex, hypertension status, and prior ischemic stroke or transient ischemic accident. CMB in the opioid use group were more likely to be deep (40.4% vs 27.3%, p = 0.023) compared to those without opioid use.
Our findings support an association between CMB, an early marker of cerebral vasculopathy, and cocaine and opioid use. These results highlight the need for further research into the pathophysiological mechanisms linking IDU to cerebrovascular injury and underscore the importance of targeted interventions in this population.
脑微出血（CMB）是脑小血管病的信号，与缺血性卒中相关。虽然非法药物使用（IDU）与脑血管病有关，但CMB与IDU之间的关联尚不清楚。
我们的主要目的是探讨IDU与CMB之间的关系，并描述有和没有CMB的患者在血管危险因素方面的差异。
我们纳入了2009年至2018年期间1746例（1614例不同患者）急性缺血性卒中和短暂性脑缺血发作患者，这些患者均有可读的T2*梯度回波序列脑磁共振成像（MRI）。我们回顾性获取了患者特征和IDU数据（通过病史和/或尿液毒理学）。对MRI进行CMB检查，并按部位分为脑叶、深部或幕下。单因素分析用于评估有和没有CMB的患者在特征上的差异，以及按药物类别分组的CMB位置变化。联合多因素逻辑/泊松回归用于描述药物类别分组与CMB之间的关联。
在我们以黑人为主的中年人群中，我们观察到13.8%（n = 241）的患者有IDU，32.9%（n = 575）的患者有CMB。53.8%的CMB位于脑叶，27.3%位于深部，18.8%位于幕下。在IDU组中，至少有一个CMB的患者（与没有CMB的患者相比）年龄更大（56.9±11.5岁对53.6±10.5岁，p = 0.036），体重指数更低（26.6±4.4对28.1±5.9，p = 0.039），更有可能患有慢性肾病（9.5%对3.0%，p = 0.033）或既往有缺血性卒中/短暂性脑缺血发作（41.9%对25.1%，p = 0.009）。在联合多因素分析中，在控制年龄、性别、高血压状态以及既往缺血性卒中或短暂性脑缺血发作后，使用可卡因与CMB数量增加0.24相关（95%置信区间（CI）：0.09，0.38；p = 0.001），使用阿片类药物与CMB数量增加0.31相关（95%CI：0.08，0.52；p < 0.001）。与未使用阿片类药物的患者相比，使用阿片类药物组的CMB更有可能位于深部（40.4%对27.3%，p = 0.023）。
我们的研究结果支持CMB（一种脑血管病的早期标志物）与可卡因和阿片类药物使用之间存在关联。这些结果凸显了进一步研究将IDU与脑血管损伤联系起来的病理生理机制的必要性，并强调了针对该人群进行有针对性干预的重要性。
