Advertisement

Deep Cerebral Microbleeds and Renal Dysfunction in Patients with Acute Lacunar Infarcts

      Background

      Cerebral small-vessel disease (SVD) is associated with renal dysfunction such as chronic kidney disease. Although cerebral microbleeds (CMBs) are common in patients with acute lacunar infarcts (ALI), the association between renal dysfunction and CMBs in such patients remains unclear.

      Methods

      Between April 2007 and March 2013, we evaluated consecutive first-ever ALI patients, who were admitted to our hospital within 24 hours of stroke onset. CMBs were defined as focal areas of signal loss in brain parenchyma less than 5 mm on T2-weighted gradient-echo imaging. Renal dysfunction was defined as an estimated glomerular filtration rate less than 60 mL/minute/1.73 m2 on admission. Correlations between renal dysfunction and the presence (model 1) and location of CMBs (model 2; any deep or infratentorial CMBs) were determined by multivariable logistic regression analyses.

      Results

      Among 152 patients (33.6% men; mean age, 67.6 years), 53 had CMBs. Patients with CMBs were older (69.9 versus 66.3 years, P = .03) and had a higher frequency of white matter hyperintensity (WMH; 62.3% versus 25.3%, P < .001), silent lacunar infarcts (SLI; 75.5% versus 43.3%, P < .001), and renal dysfunction (41.5% versus 22.2%, P = .015) than those without CMBs. On multivariable analyses, renal dysfunction (odds ratio, 95% confidence interval; model 1: 2.38, 1.02-5.66; model 2: 2.78, 1.16-6.81), WMH (3.87, 1.76-8.80; 3.72, 1.64-8.71), SLI (3.85, 1.71-9.14; 4.20, 1.77-10.8), and diabetes mellitus (.26, .09-.63; .24, .08-.63) were independently associated with CMBs.

      Conclusions

      In patients with ALI, renal dysfunction was positively associated with CMBs independent of cerebral SVD.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wardlaw J.M.
        • Smith E.E.
        • Biessels G.J.
        • et al.
        Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration.
        Lancet Neurol. 2013; 12: 822-838
        • Greenberg S.M.
        • Vernooij M.W.
        • Cordonnier C.
        • et al.
        Cerebral microbleeds: a guide to detection and interpretation.
        Lancet Neurol. 2009; 8: 165-174
        • Yakushiji Y.
        • Noguchi T.
        • Charidimou A.
        • et al.
        Basal ganglia cerebral microbleeds and global cognitive function: the Kashima Scan Study.
        J Stroke Cerebrovasc Dis. 2015; 24: 431-439
        • Saba L.
        • Raz E.
        • Bassareo P.P.
        • et al.
        Is there an association between cerebral microbleeds and leukoaraiosis?.
        J Stroke Cerebrovasc Dis. 2015; 24: 284-289
        • Khatri M.
        • Wright C.B.
        • Nickolas T.L.
        • et al.
        Chronic kidney disease is associated with white matter hyperintensity volume: the Northern Manhattan Study (NOMAS).
        Stroke. 2007; 38: 3121-3126
        • Oksala N.K.J.
        • Salonen T.
        • Strandberg T.
        • et al.
        Cerebral small vessel disease and kidney function predict long-term survival in patients with acute stroke.
        Stroke. 2010; 41: 1914-1920
        • Otani H.
        • Kikuya M.
        • Hara A.
        • et al.
        Association of kidney dysfunction with silent lacunar infarcts and white matter hyperintensity in the general population: the Ohasama study.
        Cerebrovasc Dis. 2010; 30: 43-50
        • Ryu W.S.
        • Lee S.H.
        • Kim C.K.
        • et al.
        The relation between chronic kidney disease and cerebral microbleeds: difference between patients with and without diabetes.
        Int J Stroke. 2012; 7: 551-557
        • Cho A.H.
        • Lee S.B.
        • Han S.J.
        • et al.
        Impaired kidney function and cerebral microbleeds in patients with acute ischemic stroke.
        Neurology. 2009; 73: 1645-1648
        • Ovbiagele B.
        • Wing J.J.
        • Menon R.S.
        • et al.
        Association of chronic kidney disease with cerebral microbleeds in patients with primary intracerebral hemorrhage.
        Stroke. 2013; 44: 2409-2413
        • Nakagawa K.
        • Hirai T.
        • Takashima S.
        • et al.
        Chronic kidney disease and CHADS(2) score independently predict cardiovascular events and mortality in patients with nonvalvular atrial fibrillation.
        Am J Cardiol. 2011; 107: 912-916
        • Saji N.
        • Sato T.
        • Sakuta K.
        • et al.
        Chronic kidney disease is an independent predictor of adverse clinical outcomes in patients with recent small subcortical infarcts.
        Cerebrovasc Dis Extra. 2014; 4: 174-181
        • Adams H.P.
        • Bendixen B.H.
        • Kappelle L.J.
        • et al.
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.
        Stroke. 1993; 24: 35-41
        • Saji N.
        • Shimizu H.
        • Kawarai T.
        • et al.
        Clinical features of a first-ever lacunar infarction in Japanese patients: poor outcome in females.
        J Stroke Cerebrovasc Dis. 2011; 20: 231-235
        • Saji N.
        • Kimura K.
        • Kawarai T.
        • et al.
        Arterial stiffness and progressive neurological deficit in patients with acute deep subcortical infarction.
        Stroke. 2012; 43: 3088-3090
        • Saji N.
        • Kimura K.
        • Shimizu H.
        • et al.
        Association between silent brain infarct and arterial stiffness indicated by brachial-ankle pulse wave velocity.
        Intern Med. 2012; 51: 1003-1008
        • Saji N.
        • Kimura K.
        • Shimizu H.
        • et al.
        Silent brain infarct is independently associated with arterial stiffness indicated by cardio-ankle vascular index (CAVI).
        Hypertens Res. 2012; 35: 756-760
        • Saji N.
        • Shimizu H.
        • Kawarai T.
        • et al.
        Increased brachial-ankle pulse wave velocity is independently associated with white matter hyperintensities.
        Neuroepidemiology. 2011; 36: 252-257
        • Cordonnier C.
        • Al-Shahi Salman R.
        • Wardlaw J.
        Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting.
        Brain. 2007; 130: 1988-2003
        • Staals J.
        • Van Oostenbrugge R.J.
        • Knottnerus I.L.
        • et al.
        Brain microbleeds relate to higher ambulatory blood pressure levels in first-ever lacunar stroke patients.
        Stroke. 2009; 40: 3264-3268
        • Ovbiagele B.
        • Liebeskind D.S.
        • Pineda S.
        • et al.
        Strong independent correlation of proteinuria with cerebral microbleeds in patients with stroke and transient ischemic attack.
        Arch Neurol. 2010; 67: 45-50
        • Zhang C.R.
        • Cloonan L.
        • Fitzpatrick K.M.
        • et al.
        Determinants of white matter hyperintensity burden differ at the extremes of ages of ischemic stroke onset.
        J Stroke Cerebrovasc Dis. 2015; 24: 649-654
        • Imaizumi T.
        • Inamura S.
        • Nomura T.
        Contribution of deep microbleeds to stroke recurrence: differences between patients with past deep intracerebral hemorrhages and lacunar infarctions.
        J Stroke Cerebrovasc Dis. 2015; 24: 1855-1864
        • Kim B.J.
        • Lee S.H.
        • Kang B.S.
        • et al.
        Diabetes increases large artery diseases, but not small artery diseases in the brain.
        J Neurol. 2008; 255: 1176-1181
        • Saji N.
        • Kimura K.
        • Yagita Y.
        • et al.
        Comparison of arteriosclerotic indicators in patients with ischemic stroke: ankle-brachial index, brachial-ankle pulse wave velocity, and cardio-ankle vascular index.
        Hypertens Res. 2015; 38: 323-328
        • Seo W.K.
        • Lee J.M.
        • Park M.H.
        • et al.
        Cerebral microbleeds are independently associated with arterial stiffness in stroke patients.
        Cerebrovasc Dis. 2008; 26: 618-623
        • Song T.J.
        • Kim J.
        • Kim Y.D.
        • et al.
        The distribution of cerebral microbleeds determines their association with arterial stiffness in non-cardioembolic acute stroke patients.
        Eur J Neurol. 2014; 21: 463-469
        • Wiseman S.
        • Marlborough F.
        • Doubal F.
        • et al.
        Blood markers of coagulation, fibrinolysis, endothelial dysfunction and inflammation in lacunar stroke versus non-lacunar stroke and non-stroke: systematic review and meta-analysis.
        Cerebrovasc Dis. 2014; 37: 64-75
        • Gregoire S.M.
        • Jäger H.R.
        • Yousry T.A.
        • et al.
        Brain microbleeds as a potential risk factor for antiplatelet-related intracerebral haemorrhage: hospital-based, case-control study.
        J Neurol Neurosurg Psychiatr. 2010; 81: 679-684