Prevalence and Risk Factors of Cerebral Microbleeds among Egyptian Patients with Acute Ischemic Stroke

Abstract

Background: Cerebral microbleeds (CMBs) are markers of underlying hemorrhage-prone cerebral small vessel disease detected on MRI. They are associated with heightened risk of stroke and cognitive decline. The prevalence of CMBs among Egyptian patients with ischemic stroke is not well studied. Our aim was to detect the prevalence of CMBs and associated risk factors among Egyptian patients with ischemic stroke. Methods: A prospective, cross-sectional, single center study of consecutive patients with ischemic stroke. Patients were recruited between January 2021 to January 2022 at the Assuit University hospital in the south of Egypt. Patients with known bleeding diathesis were excluded. All participants underwent full neurological assessment, urgent laboratory investigations and MRI with T2* sequence. Results: The study included 404 patients, 191 (47.3%) of them were females. The mean age of the study population was 61±1 years and the mean NIHSS on admission was 12±5. The prevalence of CMB was 26.5%, of whom 6.5% were young adults (age ≤ 45 years). CMBs were detected in 34.6% of patients with stroke caused by large artery atherosclerosis, 28.0% small vessel disease stroke subtype, 25.2% stroke of undetermined cause and 12.1% in cardioembolic stroke. History of AF, hypertension, dyslipidemia, Fazekas score > 2, dual antiplatelets use, combined antiplatelet with anticoagulant treatment and thrombolytic therapy remained independently associated with CMBs following multivariable regression analyses. Conclusion: The high number of identified CMBs needs to inform subsequent therapeutic management of these patients. We are unable to determine whether the association between CMBs and antithrombotic use is a causal relationship or rather confounded by indication in our observational study. To understand more about the underlying cause of this finding, more studies are needed.