Gradient-echo MRI assessment of microbleed in ischemic stroke patients

ABSTRACT

Cerebral microbleeds are considered evidence of [microangiopathy], thus, they are commonly found in patients with severe leukoaraiosis and lacunar infarction. The aim of the present study was to evaluate the possible risk factors or [determinants] of microbleeds in patients with ischemia stroke, especially highlighting the association of the presence of microbleeds with small vessel vasculopathy [leukoaraiosis and lacunar infarcts]. The study included 52 patients with ischemic stroke, divided into 3 groups according to MRI findings: Group [A] patients with microbleeds +/- leukoaraiosis, Group [B] patients with leukoaraiosis without microbleeds and Group [C] patients with neither leukoaraiosis nor microbleeds [considered as a control group]. Assessment was done through clinical examination, laboratory investigations, carotid duplex, MRA and MRI brain with gradient-echo T2-weighted technique. Among the patients with microbleeds, the commonest site of microbleeds was in the deep grey nuclei followed by the hemispheric subcortical region then the brain stem while the cerebellum was involved in only 4 patients. Both groups [A] and [B] differed significantly from group [C] as they were older, hypertension was more commonly encountered and was poorly controlled. Stroke recurrence was more common among groups [A] and [B]. Furthermore, group [A] differed from group [C] in having longer duration of hypertension and more history of previous antiplatelet therapy. Group [A] differed from group [B] only concerning control of hypertension [larger number of poorly controlled patients] and number of lacunar infarcts [larger number of lacunar infarcts]. Cerebral microbleeds are commonly associated with lacunar infarctions and leukoaraiosis. Lack of proper control of hypertension [not just its mere presence or its duration] is an important determinant factor for both microbleeds and lacunar infarction, which might be complicated in the future by intra-cerebral hemorrhage