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Cerebral microbleeds shouldn’t dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhage
- Source :
- BMC Neurology, Vol 18, Iss 1, Pp 1-7 (2018), BMC Neurology
- Publication Year :
- 2018
- Publisher :
- Springer Science and Business Media LLC, 2018.
-
Abstract
- Background Intravenous tissue plasminogen activator (IV tPA) after acute ischemic stroke carries the risk of symptomatic intracerebral hemorrhage (sICH). Cerebral microbleeds (CMBs) may indicate increased risk of hemorrhage and can be seen on magnetic resonance imaging (MRI). In this study, we examined the association between CMBs and sICH, focusing on the predictive value of their presence, burden, and location. Methods Records from all patients presenting to two academic stroke centers with acute ischemic stroke treated with IV tPA over a 5-year period were retrospectively reviewed. Demographic, medical, and imaging variables were evaluated. The presence, number, and location (lobar vs nonlobar) of CMBs were noted on gradient echo MRI sequences obtained during the admission. Univariable and multivariable statistical models were used to determine the relationship between CMBs and hemorrhagic (symptomatic and asymptomatic) transformation. Results Of 292 patients (mean age 62.8 years (SD 15.3), 49% African-American, 52% women), 21% (n = 62) had at least one CMB, 1% (n = 3) had > 10 CMBs, and 1% (n = 3) were diagnosed with probable cerebral amyloid angiopathy. After treatment, 16% (n = 46) developed hemorrhagic transformation, of which 6 (2%) were sICH. There was no association between CMB presence (p = .135) or location (p = .325) with sICH; however, those with a high CMB burden (> 10 CMB) were more likely to develop sICH (OR 37.8; 95% CI: 2.7–539.3; p = .007). Conclusions Our findings support prior findings that a high CMB burden (> 10) in patients with acute stroke treated with IV tPA are associated with a higher risk of sICH. However, the overall rate of sICH in the presence of CMB is very low, indicating that the presence of CMBs by itself should not dictate the decision to treat with thrombolytics.
- Subjects :
- Male
Risk
medicine.medical_specialty
Neurology
030204 cardiovascular system & hematology
Asymptomatic
lcsh:RC346-429
Intravenous thrombolysis
03 medical and health sciences
0302 clinical medicine
Fibrinolytic Agents
Internal medicine
medicine
Humans
Stroke
lcsh:Neurology. Diseases of the nervous system
Aged
Cerebral Hemorrhage
Probability
Retrospective Studies
Intracerebral hemorrhage
Models, Statistical
medicine.diagnostic_test
business.industry
Cerebral microbleed
Magnetic resonance imaging
Retrospective cohort study
General Medicine
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Black or African American
Hospitalization
Thrombolytic therapy
Cerebral Amyloid Angiopathy
Tissue Plasminogen Activator
Cardiology
Administration, Intravenous
Female
Neurology (clinical)
Neurosurgery
Cerebral amyloid angiopathy
medicine.symptom
business
030217 neurology & neurosurgery
Research Article
Subjects
Details
- ISSN :
- 14712377
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- BMC Neurology
- Accession number :
- edsair.doi.dedup.....7f9f07c00b0d667b3725187270c0d175