Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Apr;27(4):830-5.

Combinations of the presence or absence of cerebral microbleeds and advanced white matter hyperintensity as predictors of subsequent stroke types

H Naka  1 , E Nomura, T Takahashi, S Wakabayashi, Y Mimori, H Kajikawa, T Kohriyama, M Matsumoto
Affiliations

Combinations of the presence or absence of cerebral microbleeds and advanced white matter hyperintensity as predictors of subsequent stroke types

H Naka et al. AJNR Am J Neuroradiol. 2006 Apr.

Abstract

Background and purpose: Previous studies have shown microbleeds to be a risk factor for intracerebral hemorrhage and white matter hyperintensity (WMH) to be a risk factor for ischemic stroke. This study was performed to determine whether combinations of the presence or absence of microbleeds and advanced WMH are risk factors for subsequent recurrent stroke types.

Methods: In 266 patients with stroke, microbleeds on T2*-weighted MR images were counted, and WMH on T2-weighted images was graded. Patients were divided into 4 groups by the combinations of the presence or absence of microbleeds and advanced WMH and were followed up for stroke recurrence.

Results: During a mean follow-up period of 564.8 +/- 220.5 days, 26 patients developed recurrent strokes, including 10 intracerebral hemorrhages and 16 ischemic strokes. Patients with microbleeds without advanced WMH (n = 42) developed only intracerebral hemorrhages (n = 8), and the recurrence rate of intracerebral hemorrhage in those patients estimated by the Kaplan-Meier method was the highest in the 4 groups (14.3% in 1 year and 21.2% in 2 years). In contrast, patients with advanced WMH without microbleeds (n = 39) developed only ischemic strokes (n = 6), and the estimated recurrent rate of ischemic stroke in those patients was the highest in the 4 groups (10.5% in 1 year and 17.4% in 2 years). Cox proportional hazards regression analysis revealed that microbleeds were associated with intracerebral hemorrhage (hazard ratio [HR], 85.626; 95% confidence interval [CI], 6.344-1155.649) and that advanced WMH was negatively associated with intracerebral hemorrhage (HR, 0.016; 95% CI, 0.001-0.258). Advanced WMH was associated with ischemic stroke (HR, 10.659; 95% CI, 2.601-43.678).

Conclusion: It appears that patients at high risk of subsequent intracerebral hemorrhage or ischemic stroke can be identified by combinations of the presence or absence of microbleeds and advanced WMH.

PubMed Disclaimer

Figures

Fig 1.
Fig 1.
MR and CT images obtained from a patient (70-year-old man) with intracerebral hemorrhage in the cerebellum, who had been treated with aspirin after the occurrence of lacunar infarction. A and B, Initial T2*-weighted gradient-echo images (TR/TE, 800/26; flip angle, 20°) show multiple microbleeds in the brain stem, cerebellum, basal ganglia, and cerebral hemispheres. C and D, T2-weighted spin-echo images (TR/TE, 4500/112) do not show advanced white matter hyperintensity. E and F, CT image (E) and T2*-weighted gradient-echo image (F) obtained 9 months after the lacunar infarction show occurrence of cerebellar hemorrhage.
Fig 2.
Fig 2.
MR images obtained from a patient (85-year-old woman) with lacunar infarction in the right internal capsule after the occurrence of lacunar infarction in the right corona radiata. A and B, Initial T2*-weighted gradient-echo images (TR/TE, 800/26; flip angle, 20°) show no microbleeds. C, T2-weighted spin-echo image (TR/TE, 4500/112) shows advanced white matter hyperintensity. D, Diffusion-weighted image (single-shot echo-planar spin-echo sequence; TR/TE, 5300/135; b = 1000 mm2/s) obtained 23 months after the lacunar infarction shows a hyperintense lesion in the right internal capsule, consistent with acute infarction.
See this image and copyright information in PMC

Comment in

References

    1. Tanaka A, Ueno Y, Nakayama Y, et al. Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas. Stroke 1999;30:1637–42 - PubMed
    1. Fazekas F, Kleinert R, Roob G, et al. Histopathologic analysis of foci of signal loss on gradient-echo T2-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. AJNR Am J Neuroradiol 1999;20:637–42 - PMC - PubMed
    1. Kwa VIH, Franke CL, Verbeeten B Jr, et al. Silent intracerebral microhemorrhages in patients with ischemic stroke. Ann Neurol 1998;44:372–77 - PubMed
    1. Roob G, Lechner A, Schmidt R, et al. Frequency and location of microbleeds in patients with primary intracerebral hemorrhage. Stroke 2000;31:2665–69 - PubMed
    1. Kato H, Izumiyama M, Izumiyama K, et al. Silent cerebral microbleeds on T2*-weighted MRI: correlation with stroke subtype, stroke recurrence, and leukoaraiosis. Stroke 2002;33:1536–40 - PubMed

Publication types