Abstract
Objectives
Recent case-reports have described an atypical cerebral microbleed (CMB) topography
after extracorporeal membrane oxygenation (ECMO). The objective of this study was
to examine the prevalence, radiographic patterns, and clinical correlates of possibly-ECMO-related
(PER) CMB.
Materials and methods
We performed a retrospective study of 307 consecutive patients receiving ECMO support
at our tertiary-care University Hospital (2013–2018). PER CMB were defined as CMB
present in corpus-callosum and/or middle cerebellar peduncle with/without involvement
of other lobar/deep structures. Leukoaraiosis was quantified using the Wahlund age-related
white matter changes scale. Patient characteristics were compared between cohorts
with and without PER CMB.
Results
Forty patients (median age 60 years; 33% vv-ECMO and 67% va-ECMO) received at-least
one MRI-brain within 3 months of ECMO support. CMB were present in 77.5% (n = 31) patients with 39% (n = 12), 17% (n = 5), and 44% (n = 14) having low (< 10 CMB), moderate (10–30 CMB), and high (> 30 CMB) burden respectively.
Among CMB-positive patients, 71% (n = 22) had PER CMB, with 91% of such cases demonstrating involvement of splenium.
Leukoaraiosis did not corelate to PER CMB presence (p = 0.267) or burden (ρ = 0.09). Patients with PER CMB had higher rates of ischemic stroke (50 vs. 33%),
intracranial hemorrhage (41 vs. 17%), and all-cause mortality (27 vs. 17%); with survivors
demonstrating no differences in their discharge disposition or modified Rankin Score.
Conclusions
Post-ECMO cerebral microbleeds have a distinct distribution pattern that commonly
involves the splenium of corpus-callosum. Their etiopathogenesis may be independent
of microvascular lipohyalinosis. This requires further study in a larger sample-size.
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 accessOne-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 DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cerebral microhemorrhage.Stroke. 2006; 37: 550-555
- Microbleed Topography, Leukoaraiosis, and cognition in probable Alzheimer disease from the Sunnybrook dementia study.Arch Neurol. 2008; 65: 790-795
- Diffuse cerebral microbleeds after extracorporeal membrane oxygenation support.Am J Respir Crit Care Med. 2015; 191: 594-596
- Outcome in patients with H1N1 influenza and cerebrovascular injury treated with extracorporeal membrane oxygenation.Neurocrit Care. 2011; 15 (Aug): 156-160
- Critical illness-associated cerebral microbleeds.Stroke. 2017; 48: 1085-1087
- Cerebral microbleeds and leukoencephalopathy in critically Ill patients with COVID-19.Stroke. 2020; 51: 2649-2655
- Cerebral microbleeds after use of extracorporeal membrane oxygenation in children.J Neuroimaging. 2013; 23: 75-78
- Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?.Stroke Vasc Neurol. 2020; 5: 315-322
- Letter by Uchino and Cho regarding article, "Infarction of the Splenium of the corpus callosum in the age of COVID-19: a snapshot in time.Stroke. 2020; 51: e380
- Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis.Ann Cardiothorac Surg. 2019; 8: 1-8
- Brain magnetic resonance imaging in adult survivors of extracorporeal membrane oxygenation.Perfusion. 2020; 12267659120968026
- European task force on age-related white matter changes. A new rating scale for age-related white matter changes applicable to MRI and CT.Stroke. 2001; 32: 1318-1322
- Is there an association between cerebral microbleeds and leukoaraiosis?.J Stroke Cerebrovasc Dis. 2015; 24: 284-289
- Periventricular and deep white matter leukoaraiosis have a closer association with cerebral microbleeds than age.Eur J Neurol. 2012; 19: 98-104
- MR features of diseases involving bilateral middle cerebellar peduncles.AJNR Am J Neuroradiol. 2003; 24: 1946-1954
- Reversible dentate nucleus and corpus callosum lesions in acute Legionnaires’ disease.Int J Case Rep Images. 2018; 9 (100943Zo1KT2018): 1
- Microhemorrhages in nonfatal high-altitude cerebral edema.J Cereb Blood Flow Metab. 2008; 28: 1635-1642
- The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology.Crit Care. 2016; 20: 387
- C-reactive protein levels are associated with cerebral small vessel-related lesions.Acta Neurol Scand. 2016; 133: 68-74
- A murine model of inflammation-induced cerebral microbleeds.J Neuroinflamm. 2016; 13: 218
- Pathophysiological concepts of stroke in hemodynamic risk zones: do hypoperfusion and embolism interact?.Nat Clin Pract Neurol. 2008; 4: 216-225
- Clinical significance of cerebrovascular gas emboli during polidocanol endovenous ultra-low nitrogen microfoam ablation and correlation with magnetic resonance imaging in patients with right-to-left shunt.J Vasc Surg. 2011; 53: 131-137
- Microembolic signals and strategy to prevent gas embolism during extracorporeal membrane oxygenation.J Cardiothorac Surg. 2010; 5: 5
- D-dimers are a predictor of clot volume inside membrane oxygenators during extracorporeal membrane oxygenation.Artif Organs. 2015; 39: 782-787
Article info
Publication history
Published online: October 23, 2021
Accepted:
October 10,
2021
Received in revised form:
October 3,
2021
Received:
July 19,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106170
Copyright
© 2021 Elsevier Inc. All rights reserved.
