Published Online
on February 9, 2006

A more recent version of this article appeared on March 1, 2006

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Submitted on November 9, 2005
Revised on December 21, 2005
Accepted on January 9, 2006

Cerebral Microhemorrhages Predict New Disabling or Fatal Strokes in Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Jean-Martin Boulanger MD^*; Shelagh B. Coutts MD; Michael Eliasziw PhD; A. J. Gagnon MD; Jessica E. Simon MBChB; Suresh Subramaniam MD; Chul-Ho Sohn MD; James Scott MD; Andrew M. Demchuk MD; for the VISION Study Group

From the Seaman Family MR Research Centre (J.-M.B., S.B.C., A.J.G., J.E.S., S.S., C.-H.S., J.S., A.M.D.), Foothills Medical Centre, Calgary Health Region, Canada; Departments of Clinical Neurosciences (J.-M.B., S.B.C., M.E., A.J.G., J.E.S., S.S., A.M.D.), Community Health Sciences (M.E.), Medicine (J.E.S.), and Radiology (J.S.), University of Calgary, Canada; and Department of Radiology (C.-H.S.), Keimyung University, South Korea.

^* To whom correspondence should be addressed. E-mail: jbouboul{at}hotmail.com.

Background and Purpose--Cerebral microhemorrhages (MHs) are common among patients presenting with acute ischemic stroke and may predict both subsequent ischemic and hemorrhagic strokes.

Methods--We prospectively studied patients with and without MHs presenting within 12 hours of their ischemic stroke or transient ischemic attack (TIA). A magnetic resonance (MR) scan was performed within 24 hours of symptom(s) onset. The primary outcome was disabling or fatal stroke at 18 months.

Results--An MR scan was done in 236 patients with acute ischemic stroke or TIA. Forty-five (19.1%) patients had an MH on a baseline MR scan. Patients with MHs were 2.8x (10.8% versus 4.0%; P=0.036) more likely to have a subsequent disabling or fatal stroke than patients without an MH. The risk of symptomatic intracerebral hemorrhage was not statistically significant among MH and non-MH patients (3.3% versus 0.8%; P=0.31).

Conclusions--The presence of cerebral MH(s) in patients with acute ischemic stroke or TIA predicts recurrent disabling and fatal strokes. This risk is mainly assumed by recurrent ischemic strokes.

Key words: cerebral infarction • intracerebral hemorrhage • magnetic resonance imaging

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