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Background and purpose: Whilst retinal microvasculature represents cerebral small vessels, the retinal nerve fiber layer is the extended white matter of the brain. The aim was to investigate the correlation between changes in retina and white matter hyperintensities (WMHs). Methods: Sixty‐four candidates with WMHs received an optical coherence tomography angiography examination. WMHs were divided into mild or moderate/severe groups according to the Fazekas score. After imaging the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the microvascular density parameters (vascular perfusion density [VPD], vascular length density [VLD] and fovea avascular zone area) and morphological parameters (vessel diameter index [VDI], fractal dimension [FD] and vessel tortuosity) were identified. A software algorithm measured the thickness of the peripapillary retina nerve fiber layer (PRNFL). Results: Thirty‐two were classified as having mild WMHs and 32 were moderate/severe. The median (interquartile range) ages of the two groups were 58 (54–64) and 61 (57–67) years, respectively. A decrease of FD, VPD and VLD in either SCP or DCP appeared with an increased risk of moderate/severe WMHs. Although changes of capillary plexus were not associated with paraventricular WMHs, decreased FD, VPD, VLD and fovea avascular zone area in either SCP or DCP were associated with an increased risk of moderate/severe deep WMHs (DWMHs). Participants with moderate/severe WMHs demonstrated reduced PRNFL thickness, particularly in the DWMHs, compared with mild WMHs. Conclusions: Abnormalities of retinal microvascular density, morphological parameters and PRNFL thickness are correlated with the incidence of moderate/severe WMHs, particularly the DWMHs, suggesting that arteriosclerosis and hypoperfusion are the causes of DWMHs. [ABSTRACT FROM AUTHOR]

Background and purpose: The aim was to investigate whether cerebral small vessel disease (CSVD) markers and the total CSVD burden are associated with functional outcome, mortality, stroke recurrence and haematoma expansion in patients with spontaneous intracerebral haemorrhage (ICH). Methods: Following a previously registered protocol (PROSPERO protocol: CRD42021287743), PubMed, Web of Science and Embase were systematically searched to identify relevant literature up to November 2021. Cohort studies that examined the association between CSVD markers (white matter hyperintensity [WMH], lacune, enlarged perivascular space [EPVS], cerebral microbleed [CMB] and brain atrophy) or CSVD burden and prognosis in patients with ICH were included. The pooled estimates were calculated using random effects models. Results: Forty‐one studies with 19,752 ICH patients were pooled in the meta‐analysis. WMH (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.32–1.70), lacune (OR = 1.32, 95% CI 1.18–1.49), CMB (OR = 2.60, 95% CI 1.13–5.97) and brain atrophy (OR = 2.22, 95% CI 1.48–3.31) were associated with worse functional outcome. CSVD markers concerning increased risk of mortality were WMH (OR = 1.57, 95% CI 1.38–1.79) and brain atrophy (OR = 1.84, 95% CI 1.11–3.04), and markers concerning increased risk of stroke recurrence were WMH (OR = 1.62, 95% CI 1.28–2.04) and lacune (OR = 3.00, 95% CI 1.68–5.37). Enlarged perivascular space was not related to prognosis. There was a lack of association between CSVD markers and haematoma expansion. CSVD burden increased the risk of worse functional outcome, mortality and stroke recurrence by 57%, 150% and 44%, respectively. Conclusions: In patients with spontaneous ICH, WMH, lacune, CMB, brain atrophy and the total CSVD burden are associated with substantially increased risk of worse functional outcome, mortality or stroke recurrence. [ABSTRACT FROM AUTHOR]

Background: Strains of Streptococcus mutans expressing the cell surface collagen‐binding protein, Cnm, encoded by cnm (cnm‐positive S. mutans), are associated with hypertensive intracerebral hemorrhage (ICH) and the occurrence of cerebral microbleeds (CMBs). Small diffusion‐weighted imaging (DWI) hyperintensities in patients with acute ICH are also associated with CMBs. However, the association between cnm‐positive S. mutans and DWI hyperintensities is unclear. Hence, this study aimed to investigate the association between cnm‐positive S. mutans and DWI hyperintensities in patients with acute ICH. Methods: Patients with acute ICH were prospectively registered at three hospitals. Dental plaque specimens were collected within 4 days after admission, and cnm‐positive S. mutans was detected using the polymerase chain reaction. Magnetic resonance imaging at 14 ± 5 days after admission was used to evaluate DWI hyperintensities and CMBs. Results: A total of 197 patients were enrolled in this study. cnm‐positive S. mutans was detected in 30 patients (15.2%), and DWI hyperintensities were observed in 56 patients (28.4%). Patients with cnm‐positive S. mutans had a higher frequency of DWI hyperintensities (50.0% vs 24.6%; p = 0.008) and a higher number of CMBs (5.5 vs 1.5; p < 0.001) than those without cnm‐positive S. mutans. Multivariable logistic analysis revealed that the presence of cnm‐positive S. mutans was independently associated with DWI hyperintensities (OR 2.38; 95% CI 1.01–5.61; p = 0.047) after adjusting for several confounding factors. Conclusion: This study found an association between the presence of cnm‐positive S. mutans and DWI hyperintensities in patients with acute ICH. [ABSTRACT FROM AUTHOR]

Background and Purpose: Cerebral microbleeds (CMBs) are extravasations of blood from lipohyalinized or amyloid angiopathic cerebral arterioles, and the presence and numbers of CMBs are significantly associated with the development of oral anticoagulation (OA)-related intracranial haemorrhage (ICH). The aim of this study was to investigate whether there is a difference in CMBs burden according to CHADS(2) scores or CHA(2) DS(2) -VASc scores in non-valvular atrial fibrillation (NVAF) patients., Methods: We included 550 ischaemic stroke patients who had NVAF and who had undergone brain magnetic resonance imaging (MRI) with gradient-recalled echo (GRE) T2 sequences from our prospective stroke registry between January 2005 and November 2011. We calculated CHADS(2) scores and CHA(2) DS(2) -VASc scores for all patients based on their underlying cardiovascular diseases. The presence, location and number of CMBs were assessed in each patient. We also investigated whether the CMBs were actually associated with the development of ICH during follow-up., Results: The mean patient age was 70.4 ± 10.5 years, and 324 (58.9%) patients were men. One-hundred and seventy-three patients (31.5%) had CMBs detected on GRE MRI. Higher CHADS(2) scores or CHA(2) DS(2) -VASc scores were strongly associated with the presence and number of CMBs. During follow-up of median 3.1 ± 1.6 years, the presence of CMBs was independently associated with the development of ICH, whilst the CHADS(2) scores or CHA(2) DS(2) -VASc scores were not., Conclusions: Considering the positive association between the presence of CMBs and OA-related ICH, our results suggest that the increase in ICH in high-risk groups during OA may be related to an increased burden of CMBs., (© 2012 The Author(s) European Journal of Neurology © 2012 EFNS.)

Background and purpose Cerebral microbleeds ( CMBs) are associated with an increased risk of intracerebral hemorrhage. The impact of oral anticoagulation ( OAC) on CMBs is not well characterized. Our aim was to assess the prevalence of CMBs in stroke and transient ischaemic attack ( TIA) patients with atrial fibrillation ( AF) and to analyze the implications of previous treatment with OAC. Methods In this retrospective analysis on data from a prospectively recruiting stroke registry, patients with ischaemic stroke or TIA with brain magnetic resonance imaging including susceptibility weighted imaging were consecutively enrolled during a 3-year period. For each patient cardiovascular risk factors, AF history and recent diagnosis of AF, present use of OAC and antiplatelets, the National Institute of Health Stroke Scale and the premorbid modified Rankin Scale score were recorded. Two independent raters identified CMBs according to consensus criteria. CMB location was classified as lobar, deep or in the posterior fossa. Results In all, 785 patients (mean age 63.9 ± 14.2 years) were included. At least one CMB was detected in 186 (23.7%) patients. CMBs were significantly more frequent in patients with AF (30.5% vs. 22.4%). Patients with previous OAC treatment were more likely to have CMBs (36.7% vs. 22.8%, P = 0.03) and abundant CMBs ( n > 10) were more frequent in anticoagulated patients even after adjustment for age. However, age was the only independent factor predicting CMBs ( P = 0.001). Conclusions Cerebral microbleeds are common in elderly AF patients with acute ischaemic stroke. Previous OAC is associated with a higher number of CMBs predominantly in the lobar location. Establishing a causal relationship requires prospective longitudinal investigation. [ABSTRACT FROM AUTHOR]

Background and purpose Cerebral microbleeds ( CMBs) are extravasations of blood from lipohyalinized or amyloid angiopathic cerebral arterioles, and the presence and numbers of CMBs are significantly associated with the development of oral anticoagulation ( OA)-related intracranial haemorrhage ( ICH). The aim of this study was to investigate whether there is a difference in CMBs burden according to CHADS2 scores or CHA2 DS2- VASc scores in non-valvular atrial fibrillation ( NVAF) patients. Methods We included 550 ischaemic stroke patients who had NVAF and who had undergone brain magnetic resonance imaging ( MRI) with gradient-recalled echo ( GRE) T2 sequences from our prospective stroke registry between January 2005 and November 2011. We calculated CHADS2 scores and CHA2 DS2- VASc scores for all patients based on their underlying cardiovascular diseases. The presence, location and number of CMBs were assessed in each patient. We also investigated whether the CMBs were actually associated with the development of ICH during follow-up. Results The mean patient age was 70.4 ± 10.5 years, and 324 (58.9%) patients were men. One-hundred and seventy-three patients (31.5%) had CMBs detected on GRE MRI. Higher CHADS2 scores or CHA2 DS2- VASc scores were strongly associated with the presence and number of CMBs. During follow-up of median 3.1 ± 1.6 years, the presence of CMBs was independently associated with the development of ICH, whilst the CHADS2 scores or CHA2 DS2- VASc scores were not. Conclusions Considering the positive association between the presence of CMBs and OA-related ICH, our results suggest that the increase in ICH in high-risk groups during OA may be related to an increased burden of CMBs. [ABSTRACT FROM AUTHOR]

Background: Taking an advantage of the high sensitivity of 3D T2*-weighted gradient-recalled-echo (GRE) imaging to cerebral microbleeds, we investigated the relationship between cerebral microbleeds and leukoaraiosis. Methods: Participants aged 40 years or more have been evaluated for the presence of cerebral microbleeds using 3D T2*-GRE sequence since 2006. The severity of periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) on fluid attenuated inversion recovery images was assessed using Fazekas rating scales. Multivariate logistic regression analyses were conducted after adjustment for stroke subtype, age, PVH, DWMH, hypertension, dementia, and use of platelet aggregation inhibitors. Additionally, we examined the association between cerebral microbleeds and other covariates using a Pearson's correlation analysis. Results: Amongst 389 patients, 67 patients had a single microbleed and 93 had multiple microbleeds. The prevalence of microbleeds was 83% amongst 53 patients with intracerebral hemorrhage (ICH), 49% amongst 173 with infarction, and 20% amongst 163 without any type of stroke. In the multivariate analyses, the odds ratio (95% CIs) of microbleed detection was 10.1, (4.12-24.8) for ICH, 2.33 (1.12-4.85) for atherosclerotic infarction, 1.66 (1.10-2.48) for PVH, and 1.49 (1.02-2.19) for DWMH. In the Pearson's correlation analysis, cerebral microbleeds were closely related to PVH (Pearson's correlation coefficient; 0.48) and DWMH (0.37), compared with age (0.16). Conclusions: High-grade PVH, high-grade DWMH, ICH, and atherosclerotic infarction were significantly independent predictors for cerebral microbleeds. In addition, we found that the grades of PVH and DWMH have a closer association with the number of cerebral microbleeds than age. [ABSTRACT FROM AUTHOR]

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