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Objective:To investigate the influencing factors for total number, total volume, and total iron burden of cerebral microbleeds (CMBs) and the relationship between CMBs with cognitive impairment in end-stage renal disease (ESRD) using semi-automatic quantitative susceptibility mapping (QSM).Methods:The study was a cross-sectional study. Clinical and imaging data of 46 ESRD patients with≥1 CMBs who attended Tianjin First Central Hospital from November 2018 to August 2022 were retrospectively analyzed. There were 26 males and 20 females, aged 42-75 years. All patients underwent susceptibility-weighted imaging (SWI) scanning, then SWI data was post-processed to obtain QSM. The semi-automatic dynamic programming algorithm was used to get the volume and mean susceptibility value of each CMB by sketching the boundary of CMBs. The CMBs iron load total volume were calculated. Stepwise linear regression analysis was used to explore independent influencing factors for the number, total volume, and total iron burden of CMBs in ESRD patients. Partial correlation analysis was used to explore the relationship between CMBs and cognitive impairment with the other signs of cerebral small vessel diseases as covariates.Results:In patients with ESRD, CMBs were located in the frontal lobe in 19 cases, parietal lobe in 9 cases, temporal lobe in 19 cases, occipital lobe in 14 cases, basal ganglia in 27 cases, dorsal thalamus in 15 cases, centrum semiovale in 14 cases, cerebellum in 14 cases, and brainstem in 13 cases. C-reactive protein levels (95% CI 101.81-157.85, r=0.96, P=0.001) and creatinine levels (95% CI 5.32-29.61, r=0.71, P=0.010) were influencing factors for the total iron burden of CMBs. C-reactive protein levels (95% CI 0.72-1.15, r=0.99, P=0.001) and creatinine levels (95% CI 0.03-0.22, r=0.89, P=0.014) were influencing factors for the total volume of CMBs. C-reactive protein levels (95% CI 0.10-0.12, r=0.96, P=0.001) and alkaline phosphatase levels (95% CI 0.16-0.38, r=0.59, P=0.001) were influencing factors for the number of CMBs. The total volume ( r=-0.61, P=0.009) and total iron burden ( r=-0.71, P=0.002) of CMBs in the frontal lobe were negatively correlated with cognitive function. However, although the number of CMBs in the frontal lobe was negatively correlated with cognitive function, the statistics analysis was insignificant ( r=-0.53, P=0.063). Conclusions:C-reactive protein and creatinine are influencing factors for CMBs′ total volume and total iron burden; C-reactive protein levels and alkaline phosphatase are influencing factors for the number of CMBs. The total iron burden and total volume of CMBs in the frontal lobe may be the biomarkers of cognitive impairment in patients with end-stage renal disease.
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Objective To explore the correlation between serum beta 2-microglobulin(B2M)level and cerebral microbleeds(CMB)in the elderly.Methods A retrospective analysis of 636 elderly patients with chronic diseases admitted to the Department of Neurology of our hospital from Janu-ary 2020 to November 2022 was made.On the second day after admission,venous blood samples were collected to detect the serum B2M level,and brain magnetic resonance susceptibility weigh-ted imaging was performed.Then these patients were assigned into CMB group(82 cases)and CMB-free group(554 cases).Binary logistic regression analysis was employed to identify the inde-pendent risk factors for CMB.Results Binary logistic regression analysis showed that serum B2M level was an independent risk factor for CMB in elderly patients(Model 1:β=0.179,OR=1.196,95％CI:1.017-1.407,P=0.031;Model 2:β=0.215,OR=1.240,95％CI:1.048-1.468,P=0.012)after adjusting confounding factors.ROC curve analysis indicated that the optimal cutoff value of serum B2M level in diagnosing CMB was 1.805 mg/L,with a sensitivity of 70.7％and a specificity of 52.5％,and an AUC value of 0.657(95％CI:0.595-0.719,P＜0.01).Conclusion The increment of serum B2M level is closely related to CMB in the elderly population,so the pro-tein can be used as one of indicators for prediction of CMB in the population.
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Aging brings about various changes in the brain, leading to cognitive alterations that are increasingly relevant with extended life expectancy. Dementia, characterized by chronic cognitive impairment, is on the rise due to longer life expectancy, imposing a substantial burden on healthcare systems. Dementia encompasses conditions like Alzheimer's disease (AD), vascular dementia (VaD), Lewy body dementia (LBD), and frontotemporal dementia, each with its distinct symptoms and progression. Magnetic resonance imaging (MRI), especially 3T MRI, plays a crucial role in monitoring and diagnosing dementia, aiding in patient selection for emerging therapies. Study involves a comprehensive literature search without restrictions on date, language, age/publication type. Dementia can be divided into neurodegenerative and nondegenerative categories, with AD being the most prevalent. Diagnosis relies on clinical evaluation, supported by neuroimaging techniques like MRI. Various MRI findings, such as cerebral atrophy, microbleeds, white matter hyperintensities, lacunes, and strategic infarcts, offer insights into dementia-related brain changes. These findings facilitate early diagnosis, prognosis, and treatment monitoring, with standardized assessment tools and volumetric analysis enhancing diagnostic accuracy. As life expectancy continues to rise, MRI's role in assessing cognitive impairment changes becomes increasingly vital in addressing the growing challenge of dementia.
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@#Objective To observe cerebral microbleeds （CMBs）, cognitive function, and the protein expression level of hyperphosphorylated Tau （P-Tau） in patients with cerebral infarction and obstructive sleep apnea-hypopnea syndrome （OSAHS）, to analyze their differences between the cerebral infarction+OSAHS group and the control group, and to further investigate the degree of cognitive impairment in patients with cerebral infarction and OSAHS and the association between the protein expression level of P-Tau and CMBs. Methods A prospective analysis was performed for 199 patients with cerebral infarction who were admitted to Stroke Center in our hospital from December 2019 to December 2022, among whom there were 94 patients with OSAHS （cerebral infarction+OSAHS group） and 105 patients without OSAHS （control group）, and CMBs and Montreal Cognitive Assessment （MoCA） score were assessed for the two groups. The two groups were compared in terms of changes in the protein expression level of P-Tau before treatment and after 7 and 14 days of treatment. The receiver operating characteristic （ROC） curve was used to describe the predictive efficacy of P-Tau protein level before treatment for the cognitive function of patients with cerebral infarction CMBs and OSAHS, and the Pearson correlation coefficient was used to investigate the correlation of the scores of each dimension of MoCA scale with P-Tau protein level before treatment. With the score of MoCA scale as the basis for assessing the degree of cognitive impairment, 94 patients were divided into mild impairment group, moderate impairment group, and severe impairment group, and P-Tau protein level before treatment was compared between the three groups. Results Compared with the patients in the control group, the patients with cerebral infarction and OSAHS had a significantly lower MoCA score （P<0.05） and a higher occurrence rate of CMBs, especially in those with mild grade. Before treatment, the cerebral infarction+OSAHS group had a significantly higher P-Tau protein level than the control group （P<0.05）, and after 7 and 14 days of treatment, the cerebral infarction+OSAHS group had no significant change in P-Tau protein level （P>0.05）, while the control group had a significant reduction in P-Tau protein level （P<0.05）. P-Tau protein level before treatment showed a sensitivity of 67.31% and a specificity of 90.48% in the diagnosis of cognitive impairment in the patients with cerebral infarction CMBs and OSAHS, and the Pearson correlation analysis showed that the scores of visuospatial/executive, attention and computational ability, language, abstraction, and delayed memory in MoCA scale were negatively correlated with P-Tau protein level before treatment in these patients （P<0.05）. There was a significant difference in P-Tau protein level before treatment between the mild impairment group, the moderate impairment group, and the severe impairment group （P<0.05）. Conclusion P-Tau protein level before treatment is associated with cognitive impairment in patients with cerebral infarction CMBs and OSAHS, which can guide the diagnosis and severity assessment of the disease in clinical practice.
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@#Objective Currently recognized statins are associated with the increased risk of spontaneous intracerebral hemorrhage,but there are still controversies over their association with cerebral microbleeds(CMBs). This meta-analysis systematically evaluates the association between the use of statins and CMBs. Methods CNKI,Wanfang Data,VIP,CBM,PubMed,EMBASE,The Cochrane Library,and Clinical Trials databases were searched for randomized controlled trials(RCTs) of statins and CMBs published from January 1,2016 to October 12,2022. The Cochrane Collaboration's tool for assessing risk of bias was used,Revman 5.3 software was used to assess the methodological quality of RCTs included in this study,and Stata 15.0 software was used for statistical analysis. Results A total of 7 articles involving 656 patients were included in this study. The meta-analysis showed that compared with the control group,there was a significant reduction in the number of CMBs or even disappearance of such lesions after adjuvant therapy with atorvastatin calcium adjuvant therapy(odds ratio=2.41,95% confidence interval:1.78-3.25). Conclusion Existing results show that for patients with ischemic stroke and CMBs,atorvastatin calcium in addition to basic treatment can downregulate blood lipid levels,significantly reduce the number of CMBs,and alleviate the degree of CMBs.
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Cerebral microbleed (CMB) is a type of cerebral small vessel disease (CSVD). Recently studies have found that there is a certain relationship between CMB and cognitive impairment. This article mainly reviews the etiology of CMB, the relationship between CMB and cognitive impairment, CMB and cognitive disorders and the possible mechanism of CMB-related cognitive impairment, in order to improve the understanding of cognitive impairment caused by CMB.
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Objective:To investigate the incidence, neuroimaging features, and related factors for asymptomatic cerebral small vessel disease(CSVD)in the elderly population.Methods:A total of 201 elderly people with no neurological disease history who had undergone brain magnetic resonance imaging(MRI)examination from October 2019 to August 2020 were enrolled.We calculated the total CSVD score for each participant based on lacunar infarcts(LIs), white matter hyperintensities(WMH), enlarged perivascular spaces(EPVS), and cerebral microbleeds(CMBs)(0-4 points).CSVD neuroimaging features and the correlation between CSVD markers and clinical variables were analyzed.Results:In this study, 133 cases(66.2%)showed MRI features consistent with CSVD.Of whom, LIs were present in 44(21.9%), high-grade PVWMH in 88(43.8%), high-grade DWMH in 30(14.9%), basal ganglia EPVS in 61(30.3%), and CMBs in 92(45.8%).Total CSVD burden score( OR=1.876, 95% CI: 1.045-3.364, χ2=4.441, P=0.035), PVWMH( OR=2.821, 95% CI: 1.517-5.244, χ2=10.752, P=0.001), DWMH( OR=2.130, 95% CI: 1.108-4.092, χ2=5.145, P=0.023), and EPVS( OR=3.258, 95% CI: 1.675-6.334, χ2=12.129, P=0.000)were associated with hypertension.Total CSVD burden score, PVWMH, DWMH, EPVS, and CMB were correlated with increasing age( P<0.05).LIs was positively correlated with PVWMH( b=0.231, P=0.001), DWMH( b=0.247, P=0.000)and EPVS( b=0.215, P=0.001).There was a positive relationship between PVWMH and DWMH( b=0.546, P=0.000)as well as EPVS( b=0.388, P=0.000).DWMH was also positively correlated with EPVS( b=0.357, P=0.000)and CMB( b=0.177, P=0.009). Conclusions:The incidence of asymptomatic CSVD is high in the elderly population.The total CSVD score is a useful measure to evaluate asymptomatic cerebral small vessel disease in the elderly population.Neuroimaging features of asymptomatic CSVD are mainly correlated with age and hypertension.
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Objective:To investigate the relationship between cerebral small vessel disease and thyroid hormones in the elderly.Methods:A total of 314 subjects aged ≥60 years with records of head magnetic resonance image(MRI), serum thyroid function tests and physical examinations collected in the Department of Health Care Neurology of Beijing Hospital from May 2019 to November 2020 were consecutively included for this cross-sectional study.Participants were assigned into the cerebral small vessel disease group if their head MRI presentations met the following standards: the Fazekas score ≥3 points; the Fazekas score ≥2 points, with 1 cavity; new subcortical infarcts; or cerebral microhemorrhage.Differences in thyroid function were compared between the cerebrovascular disease group(n=129)and the group without cerebrovascular disease(control group, n=185).Results:A total of 314 subjects were enrolled, of whom 129 met the head MRI standards for cerebrovascular disease, and 185 who did not meet the standards entered the control group.Comparison of thyroid function found a statistically significant difference in FT3( t=3.270, P=0.001)between the two groups.As for the association of a specific type of cerebral small vessel disease with thyroid function, there was a statistically significant difference in the FT3 level between the lacunar infarction group and the non-lacunar infarction group( t=3.106, P=0.002)and between the cerebral microhemorrhage group and the non-cerebral microhemorrhage group( t=2.125, P=0.034). Groups with different Fazekas scores in white matter hyperintensity showed statistically significant differences in rT3( F=3.092, P=0.027), FT3( F=5.427, P=0.001)and FT4( F=2.646, P=0.049). After correction for hyperlipidemia, rT3 and FT4, it was found that age( OR=1.044, 95% CI: 1.022-1.067, P=0.000), hypertension( OR=0.533, 95% CI: 0.294-0.963, P=0.037)and FT3( OR=0.276, 95% CI: 0.159-0.478, P=0.000)were related to cerebral small vessel disease. Conclusions:FT3 levels at the lower end of the normal range are associated with cerebral small vessel disease in the elderly.
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Thrombotic thrombocytopenic purpura (TTP) is a rare hematological disease with typical clinical manifestations of thrombocytopenic purpura, microangiopathic hemolytic anemia, neurological symptoms, fever and kidney damage. Two patients with TTP-associated cerebral infarction complicated with microhemorrhage and their shared specific imaging findings manifestations were reported. The magnetic resonance imaging of the 2 patients showed multiple cerebral infarctions at different stages. Susceptibility-weighted imaging showed cerebral microbleeds in the infarcted area. This special imaging feature can provide important clues for early identification and diagnosis of TTP nervous system injury.
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Objective:To investigate the clinicopathological features and imaging differential diagnosis of intravascular large B-cell lymphoma (IVLBCL) in the central nervous system (CNS).Methods:A case of CNS IVLBCL with multiple intracerebral microbleeds (CMBs) diagnosed in the Department of Neurology, Qilu Hospital of Shandong University in 2017 was reported. The clinical and imaging data, histological and immunohistochemical markers were retrospectively analyzed, and the relevant literature was reviewed.Results:The patient was a 31-year-old woman presented with headache and seizures. Cranial magnetic resonance imaging (MRI) showed multifocal lesions involving mainly the cortical and subcortical white matter (bilateral cerebral hemisphere and right cerebellar hemisphere), hyperintense signal on T 2-weighted and fluid-attenuated inversion recovery images, with hypointense signal on T 1-weigthed and diffusion-weighted images and contrast enhancement in some lesions. The susceptibility weighted imaging revealed multifocal cortical or subcortical hypointense lesions, involving mainly the subcortical white matter. Brain magnetic resonance angiography was normal. Brain magnetic resonance venography showed left side transverse sinus was hypoplastic. Cranial magnetic resonance spectroscopy showed decreased N-acetylaspartylglutamate peak, elevated choline peak and inverted lipid double peak. Her symptoms and the lesions once improved after starting steroid treatment. However, CNS recurrence occurred after 1 week of steroid withdrawal. She underwent the biopsy of the right frontotemporal lobe. The pathological examination showed multiple microscopic hemorrhages and edema scattered in the brain tissue. A large number of heterologous mononuclear cells were aggregated in small blood vessels in the parenchyma and meninges. Immunohistochemical analysis revealed that the tumor was negative for Epstein-Barr virus encoded small RNAs, CD 3, CD 10, cytokeratin and CD 138, and positive for CD 20, CD 79α, B-cell lymphoma (BCL)-2, BCL-6, myelocytomatosis oncogene (C-myc) and multiple myeloma oncogene-1 (MUM-1). The Ki67 proliferation index was about 70%. The diagnosis of IVLBCL was confirmed. Conclusions:IVLBCL in CNS is a rare and swiftly progressive disease with poor prognosis. Its clinical symptoms and imaging are nonspecific. Early diagnosis and treatment is critical. Biopsy is the gold standard for diagnosis. Random skin biopsy may be helpful for the early diagnosis. Furthermore, regarding the cause of multiple CMBs, the possibility of IVLBCL should be considered in the differential diagnosis, in addition to the common causes, such as primary angiitis of the CNS and cerebral amyloid angiopathy.
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@#Objective To investigate the relationship between cerebral microbleeds and cerebral artery stenosis in patients with large atherosclerotic cerebral infarction.Methods We retrospectively enrolled 512 patients with large atherosclerotic cerebral infarction who were the first time admitted to the Department of Neurology of our hospital from October 2018 to June 2021.According to the results from the craniocerebral magnetic sensitive weighted imaging,patients were divided into non-CMBs group and CMBs group.The purpose of this study was to investigate the risk factors and incidence rate of CMBs，the relationship between cerebral microbleeds and cerebral artery stenosis in patients with large atherosclerotic cerebral infarction.Results The incidence rate of CMBs was 39.3% in this study.Factors including age,hypertension,hyperhomocysteinemia,history of antiplatelet drug use,WMH,intracranial and extracranial artery stenosis coexisted independently with CMBs.The degree of CMBs is positively correlated with cerebral artery stenosis.Conclusion Age,hypertension,high-profile cysteinemia,anti-platelet drug application history,WMH and intracranial artery or both of extracranial vessels stenosis are independent risk factors of CMBs.The degree of CMBs is positively correlated with cerebral artery stenosis.Triacylglycerol may be a protective factor for CMBs.
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@#Objective To investigate the relationship between white matter lesions (WML) and cerebral microbleeds (CMBs) in patients with lacunar infarction (LI).Methods The clinical dataes from 129 patients with LI in our hospital were analyzed retrospectively.According to the severity of CMBs,the patients were divided into no bleeding group (n=20),mild group (n=60),moderate group (n=37) and severe group (n=12).The general data and laboratory results of patients in different groups were compared,the correlation between CMBs and white matter lesion scale (WMLs) was analyzed,the Logistic multivariate analysis was used to analyze the related factors of WML and CMBS in patients with LI.Results The age and the incidence of hypertension complication in patients with different CMBs were statistically significant (P<0.05).There were significant differences in serum HDL-C,LDL-C,hs-CRP,Hcy,CIMT levels and carotid plaque score in patients with different disease degrees of CMBs (P<0.05).Logistic regression analysis showed that age,hypertension,HDL-C,Hcy and CIMT were independent risk factors for the combined incidence of WML and CMBS in patients with LI (P<0.05).Conclusion The severity of WML in patients with LI is positively correlated with the degree of CMBs.The increase of age,history of hypertension,low-level HDL-C,high-level Hcy and CIMT are independent risk factors for the combined incidence of WML and CMBs in patients with LI.
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Objective With the help of computerized tomography (CT) and susceptibility-weighted imaging (SWI) examinations, to analyze and compare the incidence and the prevalent sites of microbleeds (CMBs) in control group, diabetes group, hypertension group and diabetic hypertension group with intracerebral CMBs. The risk factors for the onset of CMBs also will be explored, in order to provide a basis for the selection of clinical diagnosis and treatment options for CMBs. Methods A collection of 174 non-acute patients in the Department of Neurology of Shandong Electric Power Central Hospital from May 2019 to October 2020, including 101 males and 73 females, aged 45-89 years, with an average age of 72 ± 5 years. Divided into four groups according to disease types: Hypertension with type 2 diabetes group, Hypertension group, Type 2 diabetes group, Control group (no hypertension and type 2 diabetes). All patients underwent CT and MRI SWI sequence scans. The 4 groups of patients were matched in terms of gender and age, excluding the influence of gender and age. The incidence, number and distribution of CMBs in the four groups were counted, and the CT and SWI imaging manifestations of CMBs in the four groups were analyzed and compared. Results CT did not find the incidence of CMBs in the brain of patients. SWI imaging showed that CMBs were detected in 58 of 174 patients (incidence rate 33.3%), and CMBs occurred in 24 cases of diabetes and hypertension group (incidence rate 57.1%). CMBs occurred in 21 cases in the hypertension group (incidence rate 46.7%), 8 cases in the diabetes group (incidence rate 22.2%), and CMBs occurred in 5 cases in the control group (incidence rate 9.8%). The incidence of CMBs in the hypertension group and the diabetes combined with hypertension group was significantly higher than that in the control group (P < 0.05). There was no significant difference in the incidence of CMBs in patients with simple diabetes compared with the control group. Also, there was no significant difference in the incidence of CMBs between the diabetes combined with hypertension group and the simple hypertension group. Conclusion CT did not find the incidence of CMBs in the brains of patients in the non-acute phase. SWI could clearly show the CMBs of the enrolled patients. Diabetes is less likely to cause an increase in CMBs. Hypertension is significantly related to the occurrence of CMBs. CMBs associated with hypertension or/and diabetes are common in the basal ganglia and thalamus, which is different from cerebral amyloid angiopathy, which provides a basis for the choice of clinical treatment options.
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Objective:To investigate the correlation between platelet distribution width(PDW)and cerebral microbleeds(CMB)in the middle-aged and elderly population.Methods:A total of 2 839 subjects who underwent cranial magnetic resonance imaging(MRI)examination at Lishui Hospital of Zhejiang University from May 2016 to December were enrolled in this cross-sectional study.According to MRI results, subjects were divided into the CMB group(n=525)and the non-CMB group(n=2 314). Clinical data and PDW levels were compared between the two groups.CMB-related factors were analyzed by using a logistic regression equation.A receiver operating characteristics(ROC)curve was drawn to analyze the value of PDW levels in predicting the incidence of CMB.Results:The percentage of males, the proportion of smokers, the number of subjects with diabetes and serum creatinine levels were higher in the CMB group than in the non-CMB group[(55.05%(289/525) vs.45.12%(1 044/2 314), 42.67%(224/525) vs.34.67%(802/2 314), 12.76%(67/525) vs.9.51%(220/2 314), (68.91±21.38)μmol/L vs.(66.45±15.40)μmol/L, all P<0.05]. PDW levels were higher in the CMB group than in the non-CMB group(15.52±2.49)% vs.(14.67±2.90)%, χ2=93.75, P<0.05). Multivariate logistic regression analysis showed that the PDW level was an independent risk factor for CMB in the middle-aged and elderly population( OR=1.13, P<0.05). The area under the ROC curve(AUC)of PDW in predicting the incidence of CMB was 0.582, and with 15.95% as the optimal threshold value, the sensitivity and specificity were 75.0% and 41.8%.Patients were divided into the high PDW sub-group(n=1 691)and the low PDW sub-group(n=1 083)based on the PDW cutoff at 15.95%.The number of CMB and the incidence of CMB were higher in the high PDW group than in the low PDW group(0.75 vs.0.48, 23.3% or 394/1 691 vs.12.1% or 131/1 083, χ2=30.37 and 51.28, P<0.05). Conclusions:PDW levels are high in middle-aged and elderly patients with CMB, and elevated PDW levels are an independent risk factor for CMB.
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Cerebral microbleeds (CMBs) are a subclinical terminal microvascular disease in which the blood exudates or leaks out from the tiny blood vessels and the small lesions were formed by the deposition of hemosiderin in the brain tissue. The pathogenesis of cerebral microbleeds is different depending on the location, with lobar CMBs attributed to cerebral amyloid angiopathy (CAA), while cerebrovascular diseases caused by hypertension are an important cause of deep and subtentorium CMBs. The prevalence of CMBs in stroke patients is high, especially in patients with ischemic stroke treated with oral antiplatelet drugs, and long-term (>5 years) treatment may be related to CMBs and intracerebral hemorrhage (ICH) events. At the same time, a certain burden of microbleeds may cause risk of ICH in the future, but whether the bleeding risk of antiplatelet treatment overweighs the clinical benefit of antithrombotic therapy remains unclear. How to better instruct antiplatelet therapy in patients with ischemic stroke warrants further clinical investigations.
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@#Objective To analyze the association between serum homocysteine (Hcy),white matter hyperintensity (WMH) and cerebral microbleeds (CMBs).Methods 309 patients were divided into CMBs group (n=116) and control group (n=193),lobar CMBs group (n=90) and deep CMBs group (n=26),minor CMBs group (n=78) and major CMBs group (n=38),low-level Hcy group (n=158) and high level Hcy group (n=151) according to the quantity and site of CMBs and the median levels of Hcy.Results The levels of Hcy,glucose,creatinine,the total score of Fazekas scale,systolic pressure and pulse pressure difference were higher in CMBs group than control group (P<0.05);Male,systolic pressure and the total score of Fazekas scale were independent risk factors of CMBs by Logical regression (P<0.05).The scores of Fazekas scale were higher in lobar CMBs group than deep CMBs group (P<0.05);Serum Hcy,the scores of Fazekas scale were related to quantity of CMBs (P<0.05).Conclusions The serum Hcy was partcipated in the process of CMBS.The severity of WMH was correlation with lobar CMBs may play a prediction role in CMBs.
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@#Objective To explore the correlation between cerebral microbleeds and cognitive dysfunction as well as the risk factors affecting the occurrence of cognitive dysfunction.Methods A total of 113 patients with no abnormalities by transcranial magnetic resonance imaging scans admitted to our hospital from May 2018 to June 2019,clinical risk factors were recorded.MoCA was tested for cognitive function assessment.MoCA score≥26 was divided into normal cognitive function group,MoCA score<26 was divided into cognitive dysfunction,and both groups were scanned with susceptibility weighted imaging.Analyze the clinical risk factors that affect the MoCA score and the relationship between the number,incidence, anatomic location and MoCA score of cerebral cerebral microbleeds.Results There was a statistical difference in the years of education between the two groups of patients (P<0.05).The number of cerebral microbleeds lesions and the positive of cerebral microbleeds lesions were negatively correlated with the MoCA score (P<0.05).There was a negative correlation between basal ganglia microbleeds and MOCA score (P<0.05).Conclusion Few years of education may be an independent risk factor for cognitive dysfunction,and cerebral microbleeds are closely related to the occurrence of cognitive dysfunction.
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In this study, we aimed to explore the relationship among miR-22, deep cerebral microbleeds (CMBs), and post-stroke depression (PSD) 1 month after ischemic stroke. We consecutively recruited 257 patients with first-ever and recurrent acute cerebral infarction and performed PSD diagnosis in accordance with the Diagnostic and Statistical Manual IV criteria for depression. Clinical information, assessments of stroke severity, and imaging data were recorded on admission. We further detected plasma miR-22 using quantitative PCR and analyzed the relationship among miR-22, clinical data, and PSD using SPSS 23.0 software. Logistic regression showed that deep (OR=1.845, 95%CI: 1.006-3.386, P=0.047) and brain stem CMBs (OR=2.652, 95%CI: 1.110-6.921, P=0.040), as well as plasma miR-22 levels (OR=2.094, 95%CI: 1.066-4.115, P=0.032) were independent risk factors for PSD. In addition, there were significant differences in baseline National Institutes of Health Stroke Scale scores (OR=1.881, 95%CI: 1.180-3.011, P=0.007) and Widowhood scores (OR=1.903, 95%CI: 1.182-3.063, P=0.012). Analysis of the receiver operating curve (AUC=0.723, 95%CI: 0.562-0.883, P=0.016) revealed that miR-22 could predict PSD one month after ischemic stroke. Furthermore, plasma miR-22 levels in brainstem and deep CMBs patients showed an upward trend (P=0.028) relative to the others. Patients with acute ischemic stroke, having brainstem and deep cerebral microbleeds, or a higher plasma miR-22 were more likely to develop PSD. These findings indicate that miR-22 might be involved in cerebral microvascular impairment and post-stroke depression.
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Humains , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Hémorragie cérébrale/psychologie , Infarctus encéphalique/psychologie , microARN/métabolisme , Dépression/psychologie , Échelle abrégée d'appréciation psychiatrique , Récidive , Facteurs socioéconomiques , Indice de gravité de la maladie , Tronc cérébral/vascularisation , Imagerie par résonance magnétique , Marqueurs biologiques/métabolisme , Hémorragie cérébrale/métabolisme , Maladie aigüe , Facteurs de risque , Dépression/métabolismeRÉSUMÉ
Objective To investigate the early warning effect of glomerular filtration rate on cerebralmicrobleeds (CMBs) in patients with lacunar infarction. Methods A retrospective study was performed. One hundred and sixty-eight patients with lacunar infarction from January 2015 to January 2018 were selected in Tai′an Central Hospital. The CMBs group and non-CMBs group were classified according to susceptibility weighted imaging. The estimated glomerular filtration rate (eGFR) was obtained. According to the MDRD formula, the indicators of renal dysfunction in patients with different degrees of cerebral microbleeds were compared, and the related risk factors of cerebral microbleeds were analyzed by single factor and multivariate analysis. Results The blood high sensitive C-reactive protein (hs-CRP) was significantly higher in CMBs group than that in non-CMBs group: (4.29 ± 3.86) mg/L vs. (2.58 ± 2.74) mg/L, P < 0.01. The proportion of patients with elevated eGFR in CMBs group was significantly higher than that in non-CMBs group: 40.7%(33/81) vs. 11.4%(10/88), P<0.01. There were significant differences in the proportion of hypertension history [83.3% (50/60) vs. 52.4% (11/21), χ2＝6.947,P＝0.008], serum creatinine(SCr) value[(113.75 ± 71.23) μmol/L vs. (75.38 ± 38.36) μmol/L, t＝－2.346,P＝0.021] and eGFR value [(91.58 ± 31.87) ml/(min·1.73 m2) vs. (109.95 ± 29.47) ml/(min·1.73 m2),t＝2.316,P＝0.023] between CMBs groups with different distribution (P < 0.05). Multivariate Logistic regression analysis showed that the history of hypertension ( OR＝5.408; 95% CI 1.518-19.267, P＝0.008) was the risk factor of CMBs in deep/ subtentorial group.The urea nitrogen (BUN)value increased (χ2＝28.150, P < 0.01), SCr value (χ2＝47.610, P < 0.01) increased, and eGFR value (χ2＝39.067,P<0.01) decreased with the severity of CMBs, and the differences were statistically significant. The proportion of CMBs in patients with eGFR decreased group(76.7% , 33/43) was significantly higher than that in normal eGFR group (38.1%, 48/126), and the difference was statistically significant (χ2＝19.188, P < 0.01). Logistic regression analysis of multiple factors affecting cerebral microbleeds showed that history of hypertension ( OR＝3.135; 95% CI 1.343-7.321, P＝0.008), elevated hs-CRP( OR＝1.233; 95% CI 1.098-1.385, P < 0.01), eGFR decreased ( OR＝1.025; 95% CI 1.002-1.048, P＝0.033) were risk factors for cerebral microbleeds. The area under the ROC curve of eGRF was 0.694 (P＝0.042). Conclusions A history of hypertension is a risk factor for deep/infratentorial CMBs. Decreased glomerular filtration rate is an independent risk factor for cerebral microbleeds. Therefore, reminding clinicians to actively diagnose and treat patients with glomerular filtration rate decline has important clinical significance for preventing the occurrence and development of cerebral microbleeds.
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Objective To analyze the risk factors of cerebral microbleeds (CMBs) in acute cerebral infarction patients. Methods We consecutively included 255 acute cerebral infarction patients who were admitted in Neurology Department of the First Affiliated Hospital of Fujian Medical University from January 2014 to December 2016. According to the number and location of CMBs, the patients were divided into infratentorial, cortical and deep cerebral groups, each of which included non-mild and moderate-severe subgroups. The differences of the level of glomerular filtration rate (eGFR) and some common arteriosclerotic risk factors were analyzed between subgroups, and the multiple logistic regression analysis was performed. Results A total of 140 subjects (54.9%) had CMBs. In the infratentorial group, the proportion of patients who were with low eGFR level in the moderate-severe CMBs subgroup was higher than in the non-mild CMBs subgroup (P=0.024). The low eGFR level (OR=3.874, 95% CI:1.261～11.901, P=0.018) and the long duration of hypertension (OR=2.128, 95%CI: 1.004～4.510, P=0.018) were the independent risk factors of the moderate-severe infratentorial CMBs. Conclusion The low eGFR level and long duration of hypertension are risk factors for the moderate and severe infratentorial CMBs after acute ischemic stroke.