HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 65, Number 12, December 27, 2005 Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Werring, D. J. Articles by Brown, M. M. Search for Related Content PubMed PubMed Citation Articles by Werring, D. J. Articles by Brown, M. M. Related Collections All Cerebrovascular disease/Stroke Infarction Intracerebral hemorrhage Related Article

Cerebral microbleeds are common in ischemic stroke but rare in TIA

From the Stroke Research Group, Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, London, UK.

Address correspondence and reprint requests to Dr Brown, Stroke Research Group, Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; e-mail: m.brown{at}ion.ucl.ac.uk

Background: In patients with stroke, gradient-echo MRI commonly detects microbleeds, indicating small artery disease with increased risk of macroscopic intracranial bleeding. Antithrombotic treatments are frequently prescribed after TIA and stroke, but there have been no previous studies of microbleeds in TIA. Because microbleeds may predict the hemorrhagic risk of antithrombotic treatments, we studied the prevalence of microbleeds, risk factors, and pathophysiologic mechanisms in patients with ischemic stroke and TIA.

Methods: One hundred twenty-nine consecutive patients with ischemic stroke or TIA were studied with MRI including T2, fluid-attenuated inversion recovery, and gradient-echo MRI sequences. Blinded observers counted microbleeds and graded white matter T2 hyperintensities throughout the brain. TIA patients with previous ischemic stroke were excluded.

Results: Sixty-seven percent of patients had ischemic stroke; 33% had TIA. Microbleeds were found in 23% of ischemic stroke patients but only 2% of TIA patients (p < 0.001). There were no significant differences in conventional risk factors or the severity of white matter disease on T2 MRI between stroke and TIA patients. Patients with microbleeds were more often hypertensive (81 vs 59%; p = 0.04) and had more severe MRI white matter disease on T2 MRI (p = 0.003).

Conclusions: Microbleeds are common in ischemic stroke but rare in TIA, an observation not explained by differences in vascular risk factors or severity of white matter disease seen on T2 MRI. This finding has implications for the safety of antithrombotic therapy and clinical trial design in the two groups. Microbleeds may also be a new marker for severe microvascular pathology with increased risk of permanent cerebral infarction.

Supported by the Sir Jules Thorn Trust and the Stroke Association (D.J.W.); the Reta Lila Weston Trust for Medical Research (Chair in Stroke Medicine; M.M.B.); and the Stroke Association and a grant from Sanofi-Synthelabo (L.J.C.).

Disclosure: The authors report no conflicts of interest.

Received April 19, 2005. Accepted in final form September 1, 2005.

Related Article

December 27 Highlights
Neurology 2005 65: 1848-1849. [Full Text] [PDF]

This article has been cited by other articles:

				Y. Yakushiji, M. Nishiyama, S. Yakushiji, T. Hirotsu, A. Uchino, J. Nakajima, M. Eriguchi, Y. Nanri, M. Hara, E. Horikawa, et al. Brain Microbleeds and Global Cognitive Function in Adults Without Neurological Disorder Stroke, December 1, 2008; 39(12): 3323 - 3328. [Abstract] [Full Text] [PDF]

				H. Tremlett, Yinshan Zhao, and V. Devonshire Natural history of secondary-progressive multiple sclerosis Multiple Sclerosis, April 1, 2008; 14(3): 314 - 324. [Abstract] [PDF]

				M. W. Vernooij, A. van der Lugt, M. A. Ikram, P. A. Wielopolski, W. J. Niessen, A. Hofman, G. P. Krestin, and M.M.B. Breteler Prevalence and risk factors of cerebral microbleeds: The Rotterdam Scan Study Neurology, April 1, 2008; 70(14): 1208 - 1214. [Abstract] [Full Text] [PDF]

				L. H.G. Henskens, R. J. van Oostenbrugge, A. A. Kroon, P. W. de Leeuw, and J. Lodder Brain Microbleeds Are Associated With Ambulatory Blood Pressure Levels in a Hypertensive Population Hypertension, January 1, 2008; 51(1): 62 - 68. [Abstract] [Full Text] [PDF]

				C. Cordonnier, R. Al-Shahi Salman, and J. Wardlaw Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting Brain, August 1, 2007; 130(8): 1988 - 2003. [Abstract] [Full Text] [PDF]

				H. H. Dib, S. Y. Hong, Z. Bin, and S. Hongliang Health Care Costs in China: Need for Intervention Journal of Health Management, January 1, 2007; 9(1): 85 - 103. [Abstract] [PDF]

				H. Tremlett and V. Devonshire Is late-onset multiple sclerosis associated with a worse outcome? Neurology, September 26, 2006; 67(6): 954 - 959. [Abstract] [Full Text] [PDF]