Ashkan Shoamanesh1, Luciana Catanese2, Jose R Romero2, Helena Lau2, Viken L Babikian2, Oscar R Benavente3, Carlos S Kase2, Aleksandra Pikula4. 1. Department of Medicine (Neurology), McMaster University / Population Health Research Institute, Hamilton, Ontario, Canada. Electronic address: ashkan.shoamanesh@phri.ca. 2. Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA. 3. Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada. 4. Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Data on cerebral microbleeds (CMBs) in younger populations are lacking, particularly in young stroke patients. We sought to characterize CMBs in an inner city cohort of young adults with stroke. METHODS: CMB presence, count, and topography were assessed on magnetic resonance imaging (MRI) scans of 104 young stroke patients (≤49 years) presenting to Boston Medical Center between January 2006 and February 2010. Subsequent MRIs were assessed for the occurrence of new microbleeds in 29 patients. We performed cross-sectional analysis comparing baseline characteristics between patients with and without microbleeds, and between predefined microbleed burden and topography categories. We performed additional analysis to assess the determinants of new microbleeds on repeat MRI. RESULTS: Microbleeds were present in 17% of the sample. Male sex (odds ratio [OR] 5.7, 95% confidence interval [CI] 1.0-32.6, P = .049), hypertension (OR 6.2, 95% CI 1.2-32, P = .03), moderate-severe white matter hyperintensities on MRI (OR 5.8, 95% CI 1.6-29.0, P = .01), and intracerebral hemorrhage (ICH; OR 5.0, 95% CI 1.2-20, P = .03) were over-represented in patients with microbleeds. Patients who developed new microbleeds on repeat MRI (14%) had higher microbleed counts on baseline MRI (50% versus 0% ≥ 3 CMBs, P = .02), history of illicit drug use (75% versus 24%, P = .08), positive serum toxicology for cocaine (67% versus 13%, P = .11), ICH as their presenting stroke subtype (50% versus 8%, P = .08), and over-representation of moderate-severe white matter hyperintensities (75% versus 20%, P = .05). CONCLUSIONS: Results from this inner city cohort suggest that microbleeds are prevalent in young stroke patients and are largely associated with modifiable risk factors.
BACKGROUND: Data on cerebral microbleeds (CMBs) in younger populations are lacking, particularly in young strokepatients. We sought to characterize CMBs in an inner city cohort of young adults with stroke. METHODS: CMB presence, count, and topography were assessed on magnetic resonance imaging (MRI) scans of 104 young strokepatients (≤49 years) presenting to Boston Medical Center between January 2006 and February 2010. Subsequent MRIs were assessed for the occurrence of new microbleeds in 29 patients. We performed cross-sectional analysis comparing baseline characteristics between patients with and without microbleeds, and between predefined microbleed burden and topography categories. We performed additional analysis to assess the determinants of new microbleeds on repeat MRI. RESULTS: Microbleeds were present in 17% of the sample. Male sex (odds ratio [OR] 5.7, 95% confidence interval [CI] 1.0-32.6, P = .049), hypertension (OR 6.2, 95% CI 1.2-32, P = .03), moderate-severe white matter hyperintensities on MRI (OR 5.8, 95% CI 1.6-29.0, P = .01), and intracerebral hemorrhage (ICH; OR 5.0, 95% CI 1.2-20, P = .03) were over-represented in patients with microbleeds. Patients who developed new microbleeds on repeat MRI (14%) had higher microbleed counts on baseline MRI (50% versus 0% ≥ 3 CMBs, P = .02), history of illicit drug use (75% versus 24%, P = .08), positive serum toxicology for cocaine (67% versus 13%, P = .11), ICH as their presenting stroke subtype (50% versus 8%, P = .08), and over-representation of moderate-severe white matter hyperintensities (75% versus 20%, P = .05). CONCLUSIONS: Results from this inner city cohort suggest that microbleeds are prevalent in young strokepatients and are largely associated with modifiable risk factors.
Authors: Ashkan Shoamanesh; Andrea Morotti; Javier M Romero; Jamary Oliveira-Filho; Frieder Schlunk; Michael J Jessel; Alison M Ayres; Anastasia Vashkevich; Kristin Schwab; Mohammad R Afzal; Christy Cassarly; Renee H Martin; Adnan I Qureshi; Steven M Greenberg; Jonathan Rosand; Joshua N Goldstein Journal: JAMA Neurol Date: 2018-07-01 Impact factor: 18.302
Authors: Andrea Morotti; Ashkan Shoamanesh; Jamary Oliveira-Filho; Frieder Schlunk; Javier M Romero; Michael Jessel; Alison Ayres; Anastasia Vashkevich; Kristin Schwab; Christy Cassarly; Renee' Hebert Martin; Steven M Greenberg; Adnan I Qureshi; Jonathan Rosand; Joshua N Goldstein Journal: Neurocrit Care Date: 2020-02 Impact factor: 3.210
Authors: Elise D Riley; Felicia C Chow; S Andrew Josephson; Samantha E Dilworth; Kara L Lynch; Amanda N Wade; Carl Braun; Christopher P Hess Journal: J Stroke Cerebrovasc Dis Date: 2021-03-05 Impact factor: 2.136
Authors: Lily W Zhou; William J Panenka; Andrea A Jones; Kristina M Gicas; Allen E Thornton; Manraj K S Heran; David Volders; Donna J Lang; Alexandra Talia Vertinsky; Alexander Rauscher; Wayne Su; Alasdair M Barr; Gordon William MacEwan; William G Honer; Thalia S Field Journal: J Am Heart Assoc Date: 2019-06-27 Impact factor: 5.501
Authors: Florian Conrad; Sarah Hirsiger; Sebastian Winklhofer; Markus R Baumgartner; Philipp Stämpfli; Erich Seifritz; Susanne Wegener; Boris B Quednow Journal: J Psychiatry Neurosci Date: 2021-04-12 Impact factor: 6.186