MRI markers of intracerebral haemorrhage in stroke patients with atrial fibrillation. [International Journal of Stroke.10 (Suppl. 3)]

Abstract

Background and Aims: Atrial fibrillation (AF) is a major risk factor for stroke requiring anticoagulation. Cerebral microbleeds (CMBs), cortical siderosis, white matter lesions (WML) and cerebral atrophy are common MRI abnormalities in older people with stroke, and may signify greater bleeding risk. We investigated their prevalence and associations with stroke type in patients with AF. Method(s): Cross-sectional study of patients with AF admitted to the stroke unit at Monash Medical Centre (Melbourne, Australia) between 2010- 2013, and who underwent brain MRI. MRI markers were rated using standardized methods. Logistic regression was used to study their associations with stroke type adjusting for age and sex. Result(s): 170 patients, mean age 78 years (SD 9.8), 155 (91.2%) ischemic stroke, 15 (8.8%) hemorrhagic stroke. Prevalence of MRI markers were: any CMB 50%, multiple (>=2) CMBs 30%, severe atrophy 37.7%, confluent WML 18.8%, superficial siderosis 8.9%, >=1 coexistent severe abnormalities 1.8% to 12.4%. SS was strongly associated with multiple CMBs (mCMBs) (Odds Ratio, OR 8.14, p < 0.001). Compared with ischemic stroke patients, those with hemorrhagic stroke were significantly more likely to have SS (OR 4.69, p = 0.02), but not mCMBs (OR 1.90, p = 0.26), WML (OR 1.12, p = 0.86) or severe atrophy (OR 0.51, p = 0.83). Among hemorrhagic stroke patients, usage of any anticoagulant on admission was higher among those with mCMB (5/6, 83%) than among those with single (1/2, 50%) or no CMB (4/7, 57%). Conclusion(s): Cortical siderosis and multiple CMBs may be markers of bleeding risk.