The Association Between Hypertension and Cerebral Microbleeds in
Patients With CADASIL

J Korean Neurol Assoc > Volume 32(2); 2014 > Article

Journal of the Korean Neurological Association 2014;32(2): 82-87.

카다실 환자에서 고혈압과 뇌미세출혈의 연관성

이정석, 박선우 송숙근 최재철 강사윤 강지훈

제주대학교 의학전문대학원 제주대학교병원 신경과

The Association Between Hypertension and Cerebral Microbleeds in Patients With CADASIL

Jung Seok Lee

Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea

Abstract

Background: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited microangiopathy that is caused by mutations in the Notch3 gene. Typical findings from magnetic resonance imaging (MRI) include multiple subcortical lacunae, extensive white-matter change, and multiple cerebral microbleeds (CMBs). CMBs are indicative of bleeding-prone microangiopathy. The rate of intracerebral hemorrhage in CADASIL is higher in Asian patients than in Caucasian patients. However, CMBs have not been thoroughly evaluated in Asian patients. We performed a detailed analysis of the frequency and distribution pattern of CMBs and assessed whether vascular risk factors exert an independent effect on CMBs in Asian CADASIL patients.
Methods: The study population comprised 60 patients who underwent brain MRI, including T2*-weighted gradient-echo sequences. Demographic factors, vascular risk factors, and MRI findings were compared between CADASIL patients with and without CMBs. The impact of vascular risk factors on CMBs, lacunae, and white-matter hyperintensities (WMHs) was assessed by logistic regression analysis.
Results: CMBs, which were detected in 34 (56.7%) patients, exhibited a significant predilection for the thalamus (46.7%), subcortical-cortical region (35.0%), and basal ganglia (31.7%). Hypertension, lacunae, and white-matter lesions were more common in patients with CMBs. Hypertension was an independent risk factor for CMBs, lacunae, and WMHs in patients with CADASIL.
Conclusions: This study found that CMBs tended to occur in hypertensive patients with CADASIL. Further studies should focus on elucidating the association between reduced blood pressure and the number of CMBs. Key Words: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), Cerebral microbleeds (CMBs), Hypertension