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Published online before print September 16, 2009, doi:10.1212/WNL.0b013e3181bd110f)
© 2009 American Academy of Neurology Rapid appearance of new cerebral microbleeds after acute ischemic strokeFrom the Departments of Neurology (S.-B.J., S.U.K., J.S.K., D.-W.K.) and Division of Epidemiology and Biostatistics Clinical Research Center (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; and Department of Neurology (A.-H.C.), The Catholic University of Korea, St. Mary’s Hospital, Seoul, Republic of Korea. Address correspondence and reprint requests to Dr. Dong-Wha Kang, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-gu, Seoul 138-736, Republic of Korea dwkang{at}amc.seoul.kr Background: It is unknown whether the development of cerebral microbleeds (MBs), small areas of signal loss on T2*-weighted gradient-echo imaging (GRE), follows a slow or a rapid process. We hypothesized that MBs may develop rapidly after certain critical events, such as strokes, and investigated the frequency, location, and factors associated with the formation of new MBs after acute ischemic stroke. Methods: We retrospectively examined 237 consecutive acute ischemic stroke patients who underwent MRI within 24 hours and follow-up MRI during the week after symptom onset. We defined new MBs as MBs that newly appeared on follow-up GRE outside the infarcted area. We examined the association of new MBs with demographics, risk factors, laboratory data, baseline MBs, and small vessel disease (SVD; leukoaraiosis and lacunar infarctions). Results: Seventy-five patients (31.6%) had baseline MBs, and 30 (12.7%) developed new MBs. Multiple logistic regression analysis indicated that the presence of baseline MBs (odds ratio [OR] 5.72, 95% confidence interval [CI] 2.12–15.42, p = 0.001) and severe SVD (OR 2.94, 95% CI 1.12–7.77, p = 0.03) independently predicted the development of new MBs. Of the 56 new MBs, 29 (51.8%) appeared in the lobar location, 17 (30.4%) appeared in the deep location, and 10 (17.9%) appeared in the infratentorial location. Conclusions: This study suggests that new microbleeds (MBs) can develop rapidly after acute ischemic stroke. Baseline MBs and severe small vessel disease are predictors for the development of new MBs. Further studies will be needed to investigate the clinical implications and mechanisms of these findings.
Abbreviations: CI = confidence interval; DWI = diffusion-weighted imaging; ESR = erythrocyte sedimentation rate; FLAIR = fluid-attenuated inversion recovery; GRE = T2*-weighted gradient-echo imaging; ICH = intracerebral hemorrhage; MB = microbleed; OR = odds ratio; SVD = small vessel disease; T2WI = T2-weighted imaging.
e-Pub ahead of print on September 16, 2009, at www.neurology.org. Supported by a grant (M103KV010010 06K2201 01010) from the Brain Research Center of the 21st Century Frontier Research Program funded by the Ministry of Science and Technology of Korea and a grant (A060171) of the Korea Health 21 R&D Project, Ministry of Health & Welfare. Disclosure: The authors report no disclosures. Received March 17, 2009. Accepted in final form July 27, 2009.
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