Underlying embolic and pathologic differentiation by cerebral microbleeds in cryptogenic stroke

Background Cryptogenic stroke encompasses diverse emboligenic mechanisms and pathogeneses. Cerebral microbleeds (CMBs) occur differently among stroke subtypes. The association of CMBs with cryptogenic stroke is essentially unknown. Methods CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by...

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Published in:	Journal of neurology 2020-05, Vol.267 (5), p.1482-1490
Main Authors:	Kikuno, Muneaki, Ueno, Yuji, Shimizu, Takahiro, Kuriki, Ayako, Tateishi, Yohei, Doijiri, Ryosuke, Shimada, Yoshiaki, Takekawa, Hidehiro, Yamaguchi, Eriko, Koga, Masatoshi, Kamiya, Yuki, Ihara, Masafumi, Tsujino, Akira, Hirata, Koichi, Toyoda, Kazunori, Hasegawa, Yasuhiro, Aizawa, Hitoshi, Hattori, Nobutaka, Urabe, Takao
Format:	Article
Language:	eng
Subjects:	Aged Aged, 80 and over Anticoagulants Aorta Cerebral Hemorrhage - diagnosis Cerebral Hemorrhage - diagnostic imaging Cerebral Hemorrhage - epidemiology Cerebral Hemorrhage - pathology Echocardiography Female Humans Hypertension Ischemic Stroke - diagnosis Ischemic Stroke - diagnostic imaging Ischemic Stroke - epidemiology Ischemic Stroke - pathology Kidney diseases Kidneys Magnetic Resonance Imaging Male Medicine Medicine & Public Health Middle Aged Neurology Neuroradiology Neurosciences Original Communication Registries Stroke Substantia alba
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Summary:	Background Cryptogenic stroke encompasses diverse emboligenic mechanisms and pathogeneses. Cerebral microbleeds (CMBs) occur differently among stroke subtypes. The association of CMBs with cryptogenic stroke is essentially unknown. Methods CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for ESUS/CS) is a multicenter registry with comprehensive data including gradient-echo T2*-weighted magnetic resonance imaging of cryptogenic stroke patients who underwent transesophageal echocardiography. Patients’ clinical characteristics were compared according to the presence and location of CMBs. Results A total of 661 patients (68.7 ± 12.7 years; 445 males) were enrolled, and 209 (32%) had CMBs. Age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00–1.04, p = 0.020), male sex (OR 1.85, 95% CI 1.18–2.91, p = 0.007), hypertension (OR 1.71, 95% CI 1.03–2.86, p = 0.039), chronic kidney disease (OR 1.64, 95% CI 1.11–2.43, p = 0.013), deep and subcortical white matter hyperintensity (OR 1.82, 95% CI 1.16–2.85, p = 0.009), and periventricular hyperintensity (OR 2.18, 95% CI 1.37–3.46, p = 0.001) were independently associated with the presence of CMBs. Aortic complicated lesions (OR 1.78, 95% CI 1.12–2.84, p = 0.015) were associated with deep and diffuse CMBs, whereas prior anticoagulant therapy (OR 7.88, 95% CI, 1.83–33.9, p = 0.006) was related to lobar CMBs. Conclusions CMBs were common, and age, male sex, hypertension, chronic kidney disease, and cerebral white matter diseases were related to CMBs in cryptogenic stroke. Aortic complicated lesions were associated with deep and diffuse CMBs, while prior anticoagulant therapy was related to lobar CMBs.
ISSN:	0340-5354 1432-1459