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. 2019 Jan;61(1):103-107.
doi: 10.1007/s00234-018-2141-y. Epub 2018 Nov 28.

Previous chronic symptomatic and asymptomatic cerebral hemorrhage in patients with acute ischemic stroke

Ge-Fei Li  1   2 , Yi-Lan Wu  1   2 , Shuo Wang  1 , Yan-Hui Shi  1   2 , Rong Zhao  1   2 , Feng-Di Liu  1   2 , Yi-Sheng Liu  1   2 , Mei-Ting Zhuang  1   2 , Ying Zhao  1   2 , Qi Sun  3 , Guo-Hong Cui  1 , Jian-Ren Liu  4
Affiliations

Previous chronic symptomatic and asymptomatic cerebral hemorrhage in patients with acute ischemic stroke

Ge-Fei Li et al. Neuroradiology. 2019 Jan.

Abstract

Purpose: Identifying previous chronic cerebral hemorrhage (PCH), especially asymptomatic cases in patients with ischemic stroke, is essential for proper antithrombotic management. The study aimed to further clarify the prevalence of PCH and the associated factors in patients with acute ischemic stroke using multi-modal neuroimaging including susceptibility-weighted MR imaging (SWI).

Methods: This was a retrospective cross-sectional study of 382 patients with acute ischemic stroke. All patients underwent 3.0-T MRI for cranial SWI, 1.5-T or 3.0-T conventional cranial MRI, and cranial CT. Patients found with PCH were matched 1:4 with patients without PCH. Clinical manifestation, computed tomography, conventional cranial MRI, and cranial SWI were used to determine PCH. Clinical and neuroimaging findings between the patients with symptomatic vs. asymptomatic PCH were compared.

Results: Thirty-six patients (36/382, 9.4%) were determined to have had a PCH. Of these 36 patients, 17 (17/36, 47.2%, or 17/382, 4.5%) had asymptomatic PCH. Multivariable analysis showed that serum total cholesterol (OR = 0.510, 95%CI 0.312-0.832, P = 0.007), cerebral microbleeds (OR = 6.251, 95%CI 2.220-17.601, P = 0.001), and antithrombotic drugs history (OR = 3.213, 95%CI 1.018-10.145, P = 0.047) were independently associated with PCH. Asymptomatic PCH had similar clinical and neuroimaging characteristics with symptomatic PCH.

Conclusion: PCH is not uncommon in acute ischemic stroke patients. Total serum cholesterol, cerebral microbleeds on SWI, and history of antithrombotic drugs were independently associated with PCH in patients with acute ischemic stroke. Asymptomatic PCH, which is easier to be missed and has similar characteristics with symptomatic PCH, should draw much attention.

Keywords: Ischemic stroke; Previous chronic cerebral hemorrhage; Susceptibility-weighted MR imaging.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of retrospective study formal consent is not required.

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