Cerebral Microbleeds And Recurrent Ischemic Stroke

Objective: Ischemic stroke is a common type of stroke with high disability rate,fatality rate and recurrence rate.Cerebral microbleeds(CMBs)is one of the imaging manifestations of cerebral small vessel disease(CVSD),and more and more studies have found that CMBs is related to ischemic stroke,hemorrhagic stroke,cognitive impairment,and abnormal gait,etc..In recent years,studies have found that CMBs is also associated with the recurrence of ischemic stroke.Recurrent ischemic stroke has a higher rate of disability and death.In this study,acute ischemic stroke patients admitted to hospital within 72 hours after the onset of the disease were taken as the research objects.Clinical data of the patients were retrospectively collected,including previous history of ischemic stroke.To assess the imaging features of CMBs by magnetic resonance imaging(MRI)of the head,and to explore the relationship between CMBs and the long-term recurrence of ischemic stroke.Methods: This is a single center study retrospectively collected between April 2016 and June 2018 in the neurology department of Liaoning people's hospital and confirmed by magnetic resonance imaging(MRI)of the clinical data of patients with acute ischemic stroke,and recurrent ischemic stroke is defined as: the original defects of the nervous system in patients with signs and symptoms improve or disappear,on the basis of a new hair again of nerve function defect,and confirmed by head MRI.Long-term recurrence is defined as more than 6 months after the last stroke.All patients were excluded from neurological deficits caused by other diseases.First onset ischemic stroke is the first acute ischemic stroke with focal nerve function defect,which is confirmed by head MRI and does not include TIA.Patients with acute ischemic stroke were divided into two groups: recurrent group and first onset group.Clinical data collected included age and gender;Vascular risk factors(including hypertension,hyperlipidemia,diabetes,history of coronary heart disease,previous stroke,smoking history,drinking history,etc.);Relevant laboratory tests(such as fasting blood glucose,glycosylated hemoglobin,blood lipid,uric acid,homocysteine,fibrinogen,etc.)CMBs is defined as the susceptibility weighted imaging(SWI)on smaller(usually about 2 ~ 5 mm in diameter,but can be up to 10 mm)no signal region,and eliminate calcification,cross section normal blood vessels and other reasons caused by iron deposit,hemorrhagic transfer(such as melanoma),axonal injury(such as after a head injury)lesions.SWI evaluated the imaging manifestations of CMBs,including the distribution site and severity of CMBs.SPSS 21.0 software package was used for statistical treatment,and multivariate Logistic regression method was used to analyze the independent risk factors of recurrent ischemic stroke.Results:During the study period,a total of 408 patients with acute ischemic stroke who had completed the susceptibility examination were enrolled.,including 26 patients who were excluded from the study because they had been hospitalized for more than 72 hours or because of incomplete data.A total of 382 ischemic stroke patients were included,with an average age of 67.06±11.14 years,and 259 males(67.8%).Among them,145 cases(38 %)were in the recurrent group and 237 cases(62%)were in the first onset group.Among the 382 patients with ischemic stroke,198(51.8%)had CMBs,.According to CMBs severity statistics: including 116 cases(30.4%)of CMBs grade 1,34 cases(9%)of CMBs grade 2,and 48 cases(12.6%)of CMBs grade 3.According to the statistics of microbleeds site,there were 39 cases(10.2%)of cerebral lobe CMBs,66 cases(17.3%)of deep/subtensive CMBs,and 93cases(24.3%)of mixed CMBs.Comparison of baseline data between patients with CMBs and those without CMBs showed that the proportion of hypertension in patients with CMBs was higher than that without CMBs(82.85vs64.7%).2 = 16.371;P= 0.000);The proportion of cerebral hemorrhage history in patients with CMBs was higher than that in patients without CMBs(12.6%vs2.2%).2 = 14.835;P =0.000);Patients without CMBs had higher NIHSS scores than those with CMBs(Z =3.249,P = 0.001).Univariate analysis showed that the composition ratio of hypertension,glycosylated hemoglobin,CMBs composition ratio,CMBs grade 3 and CMBs composition ratio of the mixed site in the recurrent group were all higher than those in the first onset group,and the difference was statistically significant(P < 0.05).With recurrent ischemic stroke as the dependent variable,multivariate logistic analysis showed that the presence of CMBs(OR 1.77,95%OR CI 1.062-2.950,P = 0.028)and CMBs grade 3(OR 2.554,95%OR CI 1.195-5.458,P = 0.016)were independent risk factors for recurrent ischemic stroke.Conclusions: 1.Ischemic stroke has a higher incidence of CMBs(51.8%),and recurrent ischemic stroke has a higher incidence of CMBs(62.8%)than primary ischemic stroke(45.1%).2.Grade 3 cerebral microbleeds and cerebral microbleeds are independent risk factors for recurrent ischemic stroke,and the location of cerebral microbleedse has nothing to do with recurrent ischemic stroke.