Pay attention to the diagnosis and treatment of cerebral amyloid angiopathy-related inflammation / 中华神经科杂志

Cerebral amyloid angiopathy-related inflammation is an inflammatory reaction process caused by beta-amyloid protein deposited in the cortical and leptomeningeal vessels, which is a rare type of cerebral amyloid angiopathy. Most of the patients are middle-aged and elderly, and manifest as progressive cognitive impairment, headache, seizures, and focal neurological deficits. Brain magnetic resonance imaging shows asymmetric T 2/fluid attenuated inversion recovery hyperintensity in cortical and subcortical white matter, in addition to multiple cerebral microbleeds. The disease often needs to be differentiated from primary angiitis of the central nervous system, glioma, and varicella-zoster virus encephalitis. Although the disease is rare, prompt treatment with glucocorticoids and immune suppressants can reduce death and disability and significantly improve outcome. Therefore, it is necessary to improve the ability of early diagnosis and treatment of this disease.

Application of MR susceptibility weighted imaging in different cerebral diseases complicated with microbleeds and cerebral vascular malformations / 实用放射学杂志

Objective To assess the value of susceptibility weighted imaging (SWI)in the diagnosis of different cerebral diseases complicated with cerebral microbleeds (CVBs)and cerebral vascular malformations (CVMs).Methods The MRI data of 76 cases with CMBs and 25 cases with CVMs were retrospectively analyzed and the data were translated as follows:(1 )To compare the counts and detecting sensitivity of CMBs on routine MRI sequences (T1 WI,T2 WI,T2 FLAIR,DWI)with SWI.(2)To assess the difference of SWI,MIP and Phase in detecting the size,counts,intensity and edge features of CMBs.(3)To assess the advantages of SWI in the diagnosis of different CVMs.Results (1)In all 1 524 CMBs detected on SWI,294,87,361,391 CMBs were detected on T1 WI,T2 WI,T2 FLAIR and DWI respectively.The sensitivities were 19.3%,5.7%,23.7% and 5.7% on T1 WI,T2 WI,T2 FLAIR and DWI respectively.It was of statistical significance (P <0.05)in the counts and detecting sensitivity on different MRI sequences.(2) 1 524 and 1 539 CMBs were detected on SWI and MIP respectively.CMBs showed oval,dotted hypointensity or hypointensity domi-nated mixed intensity lesions which were ≤10 mm in size on SWI and MIP.1 521 CMBs were detected on Phase,which appeared as hyperintensity or hyperintensity dominated mixed intensity lesions.MIP and SWI were similar in detecting the size,counts and edge features of CMBs.And Phase was inferior compared with MIP and SWI .(3)12 cases of cerebral venous malformation were detec-ted,which all appeared as the classic Medusa head sign on SWI.6 cases of intracerebral capillary telangiectasia were detected , which were characterized as multiple small rounded even hypointense lesions ortarget signon SWI .2 cases of arteriovenous malformation (AVM)were detected on SWI,in which one case only showed multiple small vessels and gross drainage vein,and the other showed clear nidus and gross drainage veins into the sigmoid sinus.4 cases of cerebral cavernous angioma were detected.Mulberry sign, which was characterized as dotted mixed intensity lesion with hypointense ring,was noted in all the cases on SWI.One case of Sturge-Weber syndrome was detected,which showed gyriform low signal lesion on MIP imaging.And many broadened,tortuous veins in the cerebral hemispheres and near the tentorium were also noted.Conclusion SWI can be used as an important sequence for detecting CMBs.Different CVMs show their specific signs in SWI sequence.Combined with conventional MRI sequences an accurate diagnosis can be achieved most of the time.

Prognostic Impact of Cerebral Small Vessel Disease on Stroke Outcome / 대한뇌졸중학회지

Cerebral small vessel disease (SVD), which includes white matter hyperintensities (WMHs), silent brain infarction (SBI), and cerebral microbleeds (CMBs), develops in a conjunction of cumulated injuries to cerebral microvascular beds, increased permeability of blood-brain barriers, and chronic oligemia. SVD is easily detected by routine neuroimaging modalities such as brain computed tomography or magnetic resonance imaging. Research has revealed that the presence of SVD markers may increase the risk of future vascular events as well as deteriorate functional recovery and neurocognitive trajectories after stroke, and such an association could also be applied to hemorrhagic stroke survivors. Currently, the specific mechanistic processes leading to the development and manifestation of SVD risk factors are unknown, and further studies with novel methodological tools are warranted. In this review, recent studies regarding the prognostic impact of WMHs, SBI, and CMBs on stroke survivors and briefly summarize the pathophysiological concepts underlying the manifestation of cerebral SVD.

Distribution of Cerebral Microbleeds Determines Their Association with Impaired Kidney Function

BACKGROUND AND PURPOSE: Cerebral microbleeds (CMBs) are associated with various pathologies of the cerebral small vessels according to their distribution (i.e., cerebral amyloid angiopathy or hypertensive angiopathy). We investigated the association between CMB location and kidney function in acute ischemic stroke patients. METHODS: We enrolled 1669 consecutive patients with acute ischemic stroke who underwent gradient-recalled echo brain magnetic resonance imaging. Kidney function was determined using the estimated glomerular filtration rate (eGFR). CMBs were classified into strictly lobar, strictly nonlobar (i.e., only deep or infratentorial), and a combination of both lobar and nonlobar. Multinomial logistic regression analyses were used to determine the factors associated with the existence of CMBs according to their location. RESULTS: The patients were aged 66+/-12 years (mean+/-standard deviation), and 61.9% (1033/1669) of them were male. CMBs were found in 27.0% (452/1669) of the patients. The stroke subtypes of small-artery occlusion and cardioembolism occurred more frequently in those with strictly nonlobar CMBs (10.8%) and strictly lobar CMBs (48.8%), respectively. The mean eGFR was lower in the strictly nonlobar CMBs group (72+/-28 mL/min/1.73 m2) and the both lobar and nonlobar CMBs group (72+/-25 mL/min/1.73 m2) than in the no-CMBs group (86+/-29 mL/min/1.73 m2). Multivariate multinomial logistic regression revealed that eGFR <60 mL/min/1.73 m2 was independently related to strictly nonlobar CMBs (odds ratio=2.63, p=0.001). CONCLUSIONS: Impaired kidney function is associated with strictly nonlobar CMBs. Our findings indicate that the distribution of CMBs should be considered when evaluating their relationships or prognoses.

Cerebral Microbleeds: Their Associated Factors, Radiologic Findings, and Clinical Implications / 대한뇌졸중학회지

Cerebral microbleeds (CMBs) are tiny, round dark-signal lesions that are most often detected on gradient-echo MR images. CMBs consist of extravasations of blood components through fragile microvascular walls characterized by lipohyalinosis and surrounding macrophages. The prevalence of CMBs in elderly subjects with no history of cerebrovascular disease is around 5%, but is much higher in patients with ischemic or hemorrhagic stroke. Development of CMBs is closely related to various vascular risk factors; in particular, lobar CMBs are thought to be associated with cerebral amyloid angiopathy. The presence of CMBs has been hypothesized to reflect cerebral-hemorrhage-prone status in patients with hypertension or amyloid microangiopathy. Stroke survivors with CMBs have been consistently found to have an elevated risk of subsequent hemorrhagic stroke or an antithrombotic-related hemorrhagic complication, although studies have failed to establish a link between CMBs and hemorrhagic transformation after thrombolytic treatment. A large prospective study is required to clarify the clinical significance of CMBs and their utility in a decision-making index.

Incidence and Risk Factors of Cerebral Microbleeds in Patients with Ischemic Stroke / 中国康复理论与实践

@#Objective To investigate the incidence and risk factors of cerebral microbleeds(CMB) in ischemic stroke patients.Methods Patients with cerebral infarction for 1～6 months were recruited.Clinical data were recorded.MRI was reviewed blindly to determine the number of CMB and lacunar infarcts and the white matter lesions(WML).The independent risk factors of CMB were analyzed with the Logistic multivariable regression.Results 636 subjects were included.CMB were found in 250 cases(39.3%).The incidence of CMB in patients of ≤50,50～65 and >65 years old were 27.2%,38.1% and 47.6% respectively(P<0.05).CMB was more frequent in patients with more lacunar infarcts(P<0.05).The incidence of CMB in patients with negative,mild,moderate and severe WML were 21.9%,33.8%,46.9%and 63.1% respectively(P<0.05).Logistic regression analysis showed that history of hypertension(OR=1.523,95% CI 1.019～2.276),severity of WML(OR=1.535,95% CI 1.258～1.874) and lacunar infarcts(OR=1.517,95% CI 1.087～2.118) were the independent risk factors for presence of CMB.Conclusion CMB was frequent in ischemic stroke.The frequency of CMB increased with aging,grade of lacunar infarcts and WML.History of hypertension,severity of WML and lacunar infarcts were the independent risk factors for CMB presence.

Progress in Cerebral Microbleeds / 国际脑血管病杂志

As a marker of cerebral microangiopathy with a hemorrhagic tendency, the occurrence of cerebral microbleeds (CMBs) in various cerebrovascular diseases and its significance are increasingly receiving attention by the researchers and clinicians both from foreign and domestic, This article reviews the pathogenesy and imaging diagnosis, the correlations between CMBs and spontaneous intracerebral hemorrhage, ischemic stroke and cerebral amyloid angiopathy, as well as the guiding significance in thrombolysis, anticoagulation and antiplatelet aggregation therapy in ischemic stroke.