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Yabuki M, Kubo Y, Kitakami K, Oomori D, Fujiwara S, Yoshida K, Kobayashi M, Ogasawara K. Development of cerebral microbleeds and its impact on cognitive function in adult patients receiving medical management alone for ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort. Neurol Res 2022; 44:1104-1112. [PMID: 35975947 DOI: 10.1080/01616412.2022.2112375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE De novo cerebral microbleeds (CMBs) on T2*-weighted magnetic resonance imaging (MRI) develop over time in adult moyamoya disease (MMD) and are generally associated with a decline in global cognitive function. The present supplementary analysis of a 5-year prospective cohort aimed to elucidate the incidence of an interval increase in CMBs in adult patients receiving medical management alone for ischemic MMD and its impact on cognitive function. METHODS Sixty-four patients without misery perfusion in the symptomatic cerebral hemispheres at inclusion who did not experience any further ischemic symptoms or new hemorrhagic events during a 5-year follow-up period underwent T2*-weighted MRI and five kinds of neuropsychologic tests at inclusion and the end of the 5-year follow-up. RESULTS When T2*-weighted MRI was compared between inclusion and the end of the 5-year follow-up, 10 patients (15%) had an interval increase in CMBs in the symptomatic cerebral hemisphere at inclusion. The scores from two kinds of neuropsychologic tests significantly deteriorated at the end of the 5-year follow-up compared with those at inclusion in patients with an interval increase in CMBs, whereas the scores of four kinds of neuropsychologic tests significantly improved at the end of the 5-year follow-up compared with those at inclusion in patients without interval increases in CMBs, asymptomatic ischemic lesions, or angiographic disease progression. CONCLUSIONS The incidence of an interval increase in CMBs was 15% per 5 years in adult patients receiving medical management alone for ischemic MMD, and this increase was associated with a decline in cognitive decline.
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Affiliation(s)
- Masahiro Yabuki
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kei Kitakami
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Daisuke Oomori
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
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Dobashi K, Kubo Y, Kimura K, Katakura Y, Chida K, Kobayashi M, Yoshida K, Fujiwara S, Terasaki K, Ogasawara K. De Novo Cerebral Microbleeds and Cognitive Decline in Cerebral Hyperperfusion After Direct Revascularization for Adult Moyamoya Disease. J Stroke Cerebrovasc Dis 2021; 31:106166. [PMID: 34768143 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Adult patients with moyamoya disease (MMD) occasionally develop cognitive decline due to cerebral hyperperfusion following direct revascularization surgery. However, how the hyperperfusion phenomenon contributes to declines in cognitive function remains unclear. The present supplementary analysis of a prospective study aimed to determine whether cerebral hyperperfusion following direct revascularization surgery for adult MMD with ischemic presentation and misery perfusion leads to development of de novo cerebral microbleeds (CMBs) and whether postoperative cognitive decline is related to these CMBs. MATERIALS AND METHODS In total, 32 patients who underwent direct revascularization surgery also underwent T2*-weighted magnetic resonance imaging (T2*WI) and neuropsychological testing before and 2 months after surgery. Development of cerebral hyperperfusion and hyperperfusion syndrome following surgery was defined based on brain perfusion single-photon emission computed tomography (SPECT) findings and clinical symptoms. RESULTS Cerebral hyperperfusion on brain perfusion SPECT (95% confidence interval [CI], 1.1-10.8; p = 0.0175) or cerebral hyperperfusion syndrome (95%CI, 1.3-15.3; p = 0.0029) was significantly associated with postoperatively increased CMBs on T2*WI. Postoperatively increased CMBs were significantly associated with postoperative cognitive decline (95%CI, 1.8-20.4, p = 0.0041). For patients with cerebral hyperperfusion on brain perfusion SPECT, the incidence of postoperative cognitive decline was significantly greater in patients with than in those without postoperatively increased CMBs (p = 0.0294). CONCLUSIONS Cerebral hyperperfusion following direct revascularization surgery for adult MMD with ischemic presentation and misery perfusion contributes to the development of de novo CMBs and postoperative cognitive decline is related to these CMBs.
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Affiliation(s)
- Kazumasa Dobashi
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan
| | - Kazuto Kimura
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan
| | - Yasukazu Katakura
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan
| | - Kohei Chida
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan
| | - Kazunori Terasaki
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, 2-1-1 Idai-dori Yahaba-cho, Iwate 020-3695, Japan.
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Igarashi S, Ando T, Takahashi T, Yoshida J, Kobayashi M, Yoshida K, Terasaki K, Fujiwara S, Kubo Y, Ogasawara K. Development of cerebral microbleeds in patients with cerebral hyperperfusion following carotid endarterectomy and its relation to postoperative cognitive decline. J Neurosurg 2021; 135:1122-1128. [PMID: 33386017 DOI: 10.3171/2020.7.jns202353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A primary cause of cognitive decline after carotid endarterectomy (CEA) is cerebral injury due to cerebral hyperperfusion. However, the mechanisms of how cerebral hyperperfusion induces cerebral cortex and white matter injury are not known. The presence of cerebral microbleeds (CMBs) on susceptibility-weighted imaging (SWI) is independently associated with a decline in global cognitive function. The purpose of this prospective observational study was to determine whether cerebral hyperperfusion following CEA leads to the development of CMBs and if postoperative cognitive decline is related to these developed CMBs. METHODS During the 27-month study period, patients who underwent CEA for ipsilateral internal carotid artery stenosis (≥ 70%) also underwent SWI and neuropsychological testing before and 2 months after surgery, as well as quantitative brain perfusion SPECT prior to and immediately after surgery. RESULTS According to quantitative brain perfusion SPECT and SWI before and after surgery, 12 (16%) and 7 (9%) of 75 patients exhibited postoperative cerebral hyperperfusion and increased CMBs in the cerebral hemisphere ipsilateral to surgery, respectively. Cerebral hyperperfusion was associated with an increase in CMBs after surgery (logistic regression analysis, 95% CI 5.08-31.25, p < 0.0001). According to neuropsychological assessments before and after surgery, 10 patients (13%) showed postoperative cognitive decline. Increased CMBs were associated with cognitive decline after surgery (logistic regression analysis, 95% CI 6.80-66.67, p < 0.0001). Among the patients with cerebral hyperperfusion after surgery, the incidence of postoperative cognitive decline was higher in those with increased CMBs (100%) than in those without (20%; p = 0.0101). CONCLUSIONS Cerebral hyperperfusion following CEA leads to the development of CMBs, and postoperative cognitive decline is related to these developed CMBs.
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Affiliation(s)
| | | | | | | | - Masakazu Kobayashi
- 1Department of Neurosurgery and
- 2Cyclotron Research Center, Iwate Medical University School of Medicine, Morioka, Japan
| | | | - Kazunori Terasaki
- 2Cyclotron Research Center, Iwate Medical University School of Medicine, Morioka, Japan
| | | | | | - Kuniaki Ogasawara
- 1Department of Neurosurgery and
- 2Cyclotron Research Center, Iwate Medical University School of Medicine, Morioka, Japan
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Perry LA, Rodrigues M, Al-Shahi Salman R, Samarasekera N. Incident Cerebral Microbleeds After Intracerebral Hemorrhage. Stroke 2019; 50:2227-2230. [DOI: 10.1161/strokeaha.118.023746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The frequency and prognostic implications of incident cerebral microbleeds (CMB), defined as development of one or more new CMB, after intracerebral hemorrhage (ICH) is unclear. Therefore, we performed a systematic review and meta-analysis to investigate the frequency and prognostic implications of incident CMB after ICH.
Methods—
We searched Ovid Medline and Embase in May 2018 for longitudinal studies of adults who underwent brain magnetic resonance imaging at 2 or more times after ICH. We calculated the pooled proportion of adults with incident CMB and sought associations between incident CMB and clinical outcomes (death, recurrent ICH, or new ischemic stroke). We planned subgroup analyses to investigate clinical variables associated with incident CMB.
Results—
We identified 2354 publications, of which we included 4 cohort studies involving 349 patients. The pooled proportion of adults with at least one new CMB during a mean 27 months follow-up (SD 20 months) was ≈40% (95% CI, 30%–50%). In one study, as the number of incident CMB increased (0 versus 1–3 new CMB versus ≥4 new CMB) the risk of recurrent symptomatic lobar ICH increased (hazard ratio 3.0; 95% CI, 1.2–7.3). No study reported on outcomes of incident ischemic stroke or death.
Conclusions—
Incident CMB occurs in ≈40% of adults after ICH. The association of incident CMB with recurrent lobar ICH needs confirmation and their association with death and ischemic stroke investigation.
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Affiliation(s)
- Luke A Perry
- From the Centre for Clinical Brain Sciences (CCBS), University of Edinburgh
| | - Mark Rodrigues
- From the Centre for Clinical Brain Sciences (CCBS), University of Edinburgh
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Disease progression and regression in sporadic small vessel disease-insights from neuroimaging. Clin Sci (Lond) 2017; 131:1191-1206. [PMID: 28566448 DOI: 10.1042/cs20160384] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 01/17/2023]
Abstract
Cerebral small vessel disease (SVD) is considered the most important vascular contributor to the development of dementia. Comprehensive characterization of the time course of disease progression will result in better understanding of aetiology and clinical consequences of SVD. SVD progression has been studied extensively over the years, usually describing change in SVD markers over time using neuroimaging at two time points. As a consequence, SVD is usually seen as a rather linear, continuously progressive process. This assumption of continuous progression of SVD markers was recently challenged by several studies that showed regression of SVD markers. Here, we provide a review on disease progression in sporadic SVD, thereby taking into account both progression and regression of SVD markers with emphasis on white matter hyperintensities (WMH), lacunes and microbleeds. We will elaborate on temporal dynamics of SVD progression and discuss the view of SVD progression as a dynamic process, rather than the traditional view of SVD as a continuous progressive process, that might better fit evidence from longitudinal neuroimaging studies. We will discuss possible mechanisms and clinical implications of a dynamic time course of SVD, with both progression and regression of SVD markers.
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Pasquini M, Benedictus MR, Boulouis G, Rossi C, Dequatre-Ponchelle N, Cordonnier C. Incident Cerebral Microbleeds in a Cohort of Intracerebral Hemorrhage. Stroke 2016; 47:689-94. [PMID: 26839348 DOI: 10.1161/strokeaha.115.011843] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to identify prognostic and associated factors of incident cerebral microbleeds (CMBs) in intracerebral hemorrhage (ICH) survivors. METHODS Observational prospective cohort of 168 ICH survivors who underwent 1.5T magnetic resonance imaging at ICH onset and during follow-up (median scan interval, 3.4; interquartile range, 1.4-4.7) years. We used logistic regression adjusted for age, sex, and scan interval. Analyses were stratified according to the index ICH location (58 lobar ICH, 103 nonlobar ICH, excluding patients with multiple or unclassifiable ICH). RESULTS Eighty-nine (53%) patients had CMBs at ICH onset, and 80 (48%) exhibited incident CMBs during follow-up. Predictors of incident CMBs at ICH onset were ≥1 CMBs (adjusted odds ratio [aOR], 2.27; 95% confidence interval [CI], 1.18-4.35), old radiological macrohemorrhage (aOR, 6.78; 95% CI, 2.76-16.68), and CMBs in mixed location (aOR, 3.73; 95% CI, 1.67-8.31). When stratifying by ICH location, incident CMBs were associated in nonlobar ICH with incident lacunes (aOR, 2.86; 95% CI, 1.04-7.85) and with the use of antiplatelet agents (aOR, 2.89; 95% CI, 1.14-7.32). In lobar ICH, incident CMBs were associated with incident radiological macrohemorrhage (aOR, 9.76; 95% CI, 1.07-88.77). CONCLUSIONS Prognostic and associated factors of incident CMBs differed according to the index ICH location. Whereas in lobar ICH, incident CMBs were associated with hemorrhagic biomarkers, in nonlobar ICH, ischemic burden also increased. CMBs may be interesting biomarkers to monitor in randomized trials on restarting antithrombotic drugs after ICH.
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Affiliation(s)
- Marta Pasquini
- From the Univ. Lille, Inserm, CHU Lille, U 1171, Degenerative and vascular cognitive disorders, Lille, France, (M.P., G.B., C.R., N.D.-P., C.C.); Department of Neurology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Saint Philibert Hospital, Lille, France (M.P.); and Alzheimer Center and, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands (M.R.B.)
| | - Marije R Benedictus
- From the Univ. Lille, Inserm, CHU Lille, U 1171, Degenerative and vascular cognitive disorders, Lille, France, (M.P., G.B., C.R., N.D.-P., C.C.); Department of Neurology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Saint Philibert Hospital, Lille, France (M.P.); and Alzheimer Center and, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands (M.R.B.)
| | - Grégoire Boulouis
- From the Univ. Lille, Inserm, CHU Lille, U 1171, Degenerative and vascular cognitive disorders, Lille, France, (M.P., G.B., C.R., N.D.-P., C.C.); Department of Neurology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Saint Philibert Hospital, Lille, France (M.P.); and Alzheimer Center and, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands (M.R.B.)
| | - Costanza Rossi
- From the Univ. Lille, Inserm, CHU Lille, U 1171, Degenerative and vascular cognitive disorders, Lille, France, (M.P., G.B., C.R., N.D.-P., C.C.); Department of Neurology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Saint Philibert Hospital, Lille, France (M.P.); and Alzheimer Center and, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands (M.R.B.)
| | - Nelly Dequatre-Ponchelle
- From the Univ. Lille, Inserm, CHU Lille, U 1171, Degenerative and vascular cognitive disorders, Lille, France, (M.P., G.B., C.R., N.D.-P., C.C.); Department of Neurology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Saint Philibert Hospital, Lille, France (M.P.); and Alzheimer Center and, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands (M.R.B.)
| | - Charlotte Cordonnier
- From the Univ. Lille, Inserm, CHU Lille, U 1171, Degenerative and vascular cognitive disorders, Lille, France, (M.P., G.B., C.R., N.D.-P., C.C.); Department of Neurology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Saint Philibert Hospital, Lille, France (M.P.); and Alzheimer Center and, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands (M.R.B.).
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