Evaluation of Cerebral Microbleeds in Patients with Acute Ischemic Stroke

INTRODUCTION

A stroke occurs when the brain's cells die owing to a lack of blood flow. Ischemic and hemorrhagic strokes are the two types of stroke. A lack of blood flow causes an ischemic stroke, while a haemorrhage causes a hemorrhagic stroke. Both disorders impair the ability of some regions of the brain to function properly. ¹.

According to the World Health Organization, "a clinical condition characterised by rapidly emerging clinical signs of localised (or occasionally worldwide) impairment of brain function lasting more than 24 hours or leading to death with no obvious cause other than vascular origin." ^2.

Cerebral microbleeds (CMBs) are minute, chronic brain haemorrhages caused by anatomical abnormalities in the small arteries of the brain. On T2*-weighted brain MRI imaging, they appear as circular anomalies with hypo-intensity. Because CMBs are usually asymptomatic, they are frequently discovered in the brain by chance. MRI scans for people who have had a stroke or who have dementia ³.

CMBs were recently discovered to be an early imaging marker of bleeding-prone vasculopathy, and hence a predictor of symptomatic stroke, particularly intracerebral haemorrhage, and dementia in the elderly. As a result, epidemiologic evidence supporting CMBs in older populations is regarded as critical for better understanding and avoiding stroke and dementia in the future. ⁴.

Hypertensive angiopathy CMBs are expected to be concentrated in deep or infratentorial brain regions, whereas amyloid angiopathy CMBs are thought to be concentrated in cerebral lobar regions. As a result, CMB risk factors are likely to vary depending on where you live. ⁵.

The primary purpose of this study was to explore the prevalence and risk factors related with cerebral microbleeds (CMB) in acute ischemic stroke using T2* weighted imaging.

PATIENTS AND METHODS

The research took place over the course of six months and was designed as a prospective cohort study. This study includes 150 cases from the inpatient and outpatient clinics of Al-Azhar University Hospitals' neurology departments.

Patients who have been diagnosed with acute ischemic stroke clinically, radiologically, and in the lab.

Acute intracerebral haemorrhage, SAH, subdural hematoma, extradural hematoma, and haematological abnormalities are not allowed to participate.

The patients had sustained severe head traumas and had developed an A-V malformation.

Tumors, aneurysms, arteriovenous malformations, cancer, severe cardiac disease (such as heart failure), liver disease (such as cirrhosis), as well as viral and inflammatory diseases MRI is not recommended for people with acute coronary syndrome, life-threatening arrhythmias, or cardiac illness.

The Faculty of Medicine at Al-Azhar University certified the procedure and its related documents for Ethical and Research approval.

Patients or their relatives signed a written informed consent form before enrolling and starting the trial.

All of the participants in the study were subjected to the following procedures:

must have a full medical and neurological history.

Previous antithrombotic treatment (antiplatelets or anticoagulants)

The National Institute of Health Stroke Scale, which determines how severe a stroke is (NIHSS).

Standard lab tests include the following:

Complete blood count, liver function tests, prothrombin time and concentration, and the international normalised ratio (INR), Renal function tests, fasting blood glucose, and glycosylated haemoglobin (HbA1C).

lipoprotein profile:

A T2* MRI of the brain to see if any microbleeds are present. A superconducting 1.5 T unit was used to perform brain MRIs (Achieva; Philips Medical Systems, Best, the Netherlands). All of the patients were scanned using a dedicated head coil and a typical stroke technique. Among the pulse sequences were the following:

Axial T1W pictures (rapid spin-echo sequence): TR = 597 ms, TE = 15 ms, NEX = 2, flip angle 90, matrix 137 208 with a field of view (FOV) of 230 (AP) 186 (RL) 131 (FH) mm, slice thickness 5 mm, and gap 0 mm, matrix 137 208 with a field of view (FOV) of 230 (AP)

TR = 4845 ms, TE = 110 ms, NEX 2, flip angle 90, matrix 147 256, FOV 230 (AP) 183 (RL) 131 (FH) mm, slice thickness 5 mm, and gap 0 mm, NEX 2, flip angle 90, matrix 147 256, FOV 230 (AP) 183 (RL) 131 (FH) mm, slice thickness 5 mm, and gap 0 mm, TR = 4845 ms, TE = 110 ms, NEX 2, flip angle 90, matrix 147 256, FOV 230 (AP) 183 (RL) 131, NEX 2, flip angle 90, matrix 147 256, (FH)

FLAIR axial images (fluid-attenuated inversion recovery): NEX 2, flip angle 90, matrix 137 208, FOV 230 (AP) 184 (RL) 131 (FH) mm, slice thickness 5 mm, and gap 0 mm, FLAIR axial images TI (inversion time) = 2800 ms, TR = 11000 ms, TE = 130 ms, TI (inversion time) = 2800 ms, TR = 11000 ms, TE = 130 ms, TI (inversion time) = 2800 ms, TR = 11000 ms, TE = 130 ms, TI (inversion NEX 2, matrix 137 208 with FOV 230 (AP)

Axial diffusion-weighted (DW) images: TR = 3724 ms, TE = 117 ms, b value = 0 and 1000 s/mm2, matrix 105 136 with FOV 232 (AP) 202 (RL) 131 (FH) mm, slice thickness 5 mm, and gap 0 mm, matrix 105 136 with FOV 232 (AP) 202 (RL) 131 (FH) mm, slice thickness

TR = 691 ms, TE = 23 ms, matrix 133 208 with FOV 230 (AP) 184 (RL) 131 (FH) mm, slice thickness 5 mm, and gap 0 mm MRA flight time of the Willis circle, matrix 133 208 with FOV 230 (AP) 184 (RL) 131 (FH) mm, slice thickness 5 mm, and gap 0 mm MRA flight time of the Willis circle

While being blinded to the clinical information, two trained observers tallied the amount of CMBs across the entire brain. The number of CMBs split the participants into two groups: those with 0-5 and those with >5.

Statistical Analysis:

To gather, categorise, review, and tabulate data, IBM Statistical Package for the Social Sciences version 20 was utilised (SPSS). Tokens comprised numbers and percentages for qualitative data; mean, standard deviations, and ranges for quantitative data with parametric distribution; and median and interquartile range for quantitative data with nonparametric distribution (IQR). The Chi-square test was used to compare qualitative data from two groups, and when the predicted count in any cell was less than 5, the Fisher exact test was used instead of the Chi-square test. The independent t-test was used to compare two groups with quantitative data and a parametric distribution, whereas the Mann-Whitney test was used to compare two groups with quantitative data and a non-parametric distribution. The acceptable margin of error was set at 5%, while the confidence interval was set at 95%. As a result, the p-value below was deemed significant.

RESULTS

Table (1) This table showed that 55 patients (36.7%) were females and 95 patients (63.3%) were males, mean of age was 65.41 with range from 46 to 78.

Table 1: Demographic data among all patients.

Table (2) showed that 32 patients (21.3%) had AF, 17 patients (11.3%) had IHD, 92 patients (61.3%) had hyperlipidemia.

Table 2: History of  associated diseases among all patients.

Table 3: Antiplatelet medication, Type of stroke and NIHSS (present) among all patients.

Table 4: Presence, NO and Site of CMB among all patients.

Table (4) showed that NO. of CMB was 5 in 5 patients (3.3%), Site of CMB was Cortical-subcortical in 9 patients (6%), was Cortical-subcortical and deep in 10 patients (6.7%), was Infratentorial in 8 patients (5.3%).

Table 5: Demographic data among CMB.

Table (5) showed that there was statistically significant increase old age in CMB

Table 6: History among CMB.

Table (6) showed that there was statistically significant increase HTN and antiplatelet medication  in CMB.