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Cerebral Microbleeds and Thrombolysis for Acute Ischemic Stroke

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Neuroprotective Therapy for Stroke and Ischemic Disease

Part of the book series: Springer Series in Translational Stroke Research ((SSTSR))

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Abstract

Cerebral microbleeds (CMB) are small MRI signal voids due to tiny hemosiderin deposits derived from red blood cell extravasation. The relationship between CMB and postthrombolysis intracerebral hemorrhage (ICH), the most feared complication of thrombolysis for acute ischemic stroke, has received considerable attention. Individual studies relating CMB and postthrombolysis ICH have generally failed to show a significant association. However, recent meta-analyses indicate that CMB presence or burden on pretreatment MRI is associated with postthrombolysis ICH. The exact nature of the CMB–postthrombolysis ICH relationship is complicated by the heterogeneous nature of CMB and their associated risk factors hypertension, cerebral amyloid angiopathy, and chronic kidney disease. CMB may be due to a primary disruption of the vessel wall (primary CMB) or may be a consequence of ischemic brain injury (secondary CMB). Clinicians making decisions regarding whether or not to offer intravenous thrombolysis to patients with acute ischemic stroke should attempt to distinguish primary from secondary CMB, as it is the former that likely create the greatest risk for postthrombolysis ICH.

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Disclosures

Supported by NIH NS 20989

Dr. Fisher receives research support from Boehringer-Ingelheim and Otsuka Pharmaceutical Company, and serves on Clinical Events Committees for Covidien.

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Authors and Affiliations

  1. Department of Neurology, JeJu National University School of Medicine, 1 Ara-1 dong, Jeju, South Korea

    JungSeok Lee M.D., Ph.D.

  2. Department of Neurology, University of California Irvine, Irvine, CA, USA

    JungSeok Lee M.D., Ph.D.

  3. Departments of Neurology, Anatomy & Neurobiology, and Pathology & Laboratory Medicine, University of California Irvine, Irvine, CA, USA

    Mark Fisher M.D.

  4. Department of Neurology, UC Irvine Medical Center, 101 The City Drive South, Shanbrom Hall, Room 121, Orange, CA, 92868, USA

    Mark Fisher M.D.

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  1. JungSeok Lee M.D., Ph.D.
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Correspondence to Mark Fisher M.D. .

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Editors and Affiliations

  1. Department of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Paul A. Lapchak

  2. Loma Linda University School of Medicine, Loma Linda, California, USA

    John H. Zhang

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Lee, J., Fisher, M. (2017). Cerebral Microbleeds and Thrombolysis for Acute Ischemic Stroke. In: Lapchak, P., Zhang, J. (eds) Neuroprotective Therapy for Stroke and Ischemic Disease. Springer Series in Translational Stroke Research. Springer, Cham. https://doi.org/10.1007/978-3-319-45345-3_21

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  • DOI: https://doi.org/10.1007/978-3-319-45345-3_21

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