Cerebral Microbleeds Are Uncommon in Ischemic Stroke Associated with Nonvalvular Atrial Fibrillation

被引:13
作者
Chatzikonstantinou, Anastasios [1 ]
Willmann, Olaf [1 ]
Szabo, Kristina [1 ]
Hennerici, Michael G. [1 ]
机构
[1] Heidelberg Univ, Univ Klinikum Mannheim, Dept Neurol, D-68167 Mannheim, Germany
关键词
Nonvalvular atrial fibrillation; ischemic stroke; microbleeds; stroke risk; anticoagulation; T2-ASTERISK-WEIGHTED MR-IMAGES; WARFARIN-ASSOCIATED HEMORRHAGE; GRADIENT-ECHO MR; INTRACRANIAL HEMORRHAGE; HEMOSIDERIN SPOTS; RISK-FACTORS; MICROHEMORRHAGES; ANTICOAGULATION; PREVALENCE; RECURRENCE;
D O I
10.1111/j.1552-6569.2009.00440.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND AND PURPOSE Patients with cardioembolic ischemic stroke from nonvalvular atrial fibrillation (NVAF) are candidates for long-term anticoagulation. This study examines the prevalence of cerebral microbleeds (MBs) in stroke patients with NVAF. METHODS A total of 132 consecutive ischemic stroke patients with NVAF admitted to our Stroke Unit were recruited if complete magnetic resonance (MR) imaging studies including T2* imaging had been performed within less than 72 hours. National Institutes of Health Stroke Scale scores were documented and cerebrovascular risk factors were monitored. RESULTS Among 132 patients (mean age 74.1 +/- 9.8 years), only 9 (6.8%) had MBs (mean number 6.2) as detected on T2* MR images. No statistically significant differences between patients without versus with MBs were observed regarding arterial hypertension, diabetes, hyperlipidemia, and coronary heart disease. However, small vessel disease (SVD) was significantly more frequent in patients with MBs than without MBs (44.4% vs. 12.2%; P < .05) and significantly more patients with MBs experienced repeated strokes (44.4% vs. 14.6%; P < .05). CONCLUSIONS In contrast to studies reflecting a high incidence of MBs in stroke patients of various subtypes, MBs occurred less frequently in patients with cardioembolic acute ischemic stroke associated with NVAF. In patients with severe SVD or repeated cerebrovascular events, special caution should be taken regarding oral anticoagulation.
引用
收藏
页码:103 / 107
页数:5
相关论文
共 38 条
[1]   CLASSIFICATION OF SUBTYPE OF ACUTE ISCHEMIC STROKE - DEFINITIONS FOR USE IN A MULTICENTER CLINICAL-TRIAL [J].
ADAMS, HP ;
BENDIXEN, BH ;
KAPPELLE, LJ ;
BILLER, J ;
LOVE, BB ;
GORDON, DL ;
MARSH, EE ;
KASE, CS ;
WOLF, PA ;
BABIKIAN, VL ;
LICATAGEHR, EE ;
ALLEN, N ;
BRASS, LM ;
FAYAD, PB ;
PAVALKIS, FJ ;
WEINBERGER, JM ;
TUHRIM, S ;
RUDOLPH, SH ;
HOROWITZ, DR ;
BITTON, A ;
MOHR, JP ;
SACCO, RL ;
CLAVIJO, M ;
ROSENBAUM, DM ;
SPARR, SA ;
KATZ, P ;
KLONOWSKI, E ;
CULEBRAS, A ;
CAREY, G ;
MARTIR, NI ;
FICARRA, C ;
HOGAN, EL ;
CARTER, T ;
GURECKI, P ;
MUNTZ, BK ;
RAMIREZLASSEPAS, M ;
TULLOCH, JW ;
QUINONES, MR ;
MENDEZ, M ;
ZHANG, SM ;
ALA, T ;
JOHNSTON, KC ;
ANDERSON, DC ;
TARREL, RM ;
NANCE, MA ;
BUDLIE, SR ;
DIERICH, M ;
HELGASON, CM ;
HIER, DB ;
SHAPIRO, RA .
STROKE, 1993, 24 (01) :35-41
[2]   Warfarin for the prevention of systemic embolism in patients with non-valvular atrial fibrillation: a meta-analysis [J].
Andersen, L. V. ;
Vestergaard, P. ;
Deichgraeber, P. ;
Lindholt, J. S. ;
Mortensen, L. S. ;
Frost, L. .
HEART, 2008, 94 (12) :1607-1613
[3]   Analysis of risk factors involved in oral-anticoagulant-related intracranial haemorrhages [J].
Berwaerts, J ;
Webster, J .
QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS, 2000, 93 (08) :513-521
[4]   Cerebral microhemorrhages predict new disabling or fatal strokes in patients with acute ischemic stroke or transient ischemic attack [J].
Boulanger, JM ;
Coutts, SB ;
Eliasziw, M ;
Gagnon, AJ ;
Simon, JE ;
Subramaniam, S ;
Sohn, CH ;
Scott, J ;
Demchuk, AM .
STROKE, 2006, 37 (03) :911-914
[5]  
Chan S, 1996, AM J NEURORADIOL, V17, P1821
[6]  
Chesebro JH, 1996, ARCH INTERN MED, V156, P409
[7]   Cerebral microbleeds and white matter changes in patients hospitalized with lacunar infarcts [J].
Fan, YH ;
Mok, VCT ;
Lam, WWM ;
Hui, ACF ;
Wong, KS .
JOURNAL OF NEUROLOGY, 2004, 251 (05) :537-541
[8]   Cerebral microbleeds as a risk factor for subsequent intracerebral hemorrhages among patients with acute ischemic stroke [J].
Fan, YH ;
Zhang, L ;
Lam, WWM ;
Mok, VCT ;
Wong, KS .
STROKE, 2003, 34 (10) :2459-2462
[9]   Age and the risk of warfarin-associated hemorrhage: The anticoagulation and risk factors in atrial fibrillation study [J].
Fang, Margaret C. ;
Go, Alan S. ;
Hylek, Elaine M. ;
Chang, Yuchiao ;
Henault, Lori E. ;
Jensvold, Nancy G. ;
Singer, Daniel E. .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2006, 54 (08) :1231-1236
[10]   Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation [J].
Fang, MC ;
Chang, YC ;
Hylek, EM ;
Rosand, J ;
Greenberg, SM ;
Go, AS ;
Singer, DE .
ANNALS OF INTERNAL MEDICINE, 2004, 141 (10) :745-752