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Comment & Response |

The Dark Matter of Cerebral Microbleeds Implications for Thrombolysis and Other Clinical Scenarios ONLINE FIRST

Andreas Charidimou, MD, MSc (Clinical Neurology), PhD1,2
[+] Author Affiliations
1J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston
2Harvard Medical School, Boston, Massachusetts
JAMA Neurol. Published online August 15, 2016. doi:10.1001/jamaneurol.2016.2948
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To the Editor I read with interest the article by Tsivgoulis et al1 in JAMA Neurology on cerebral microbleeds (CMBs) and the risk for symptomatic intracerebral hemorrhage (ICH) after intravenous thrombolysis for acute stroke, as well as the accompanying Editorial by Fisher.2 This work follows and extends previous meta-analyses on a thorny topic for acute stroke neurology,3 demonstrating again that the presence of any number of CMBs on pretreatment magnetic resonance imaging is associated with more than doubling the risk for postthrombolysis ICH. Of importance, the authors1 provided new evidence from group-level and individual patient–level-adjusted pooled estimates demonstrating that high CMB burden (defined in the study as >10 CMBs) confers an even greater risk for bleeding (unadjusted risk ratio, 12.1; 95% CI, 4.36-33.57 and adjusted odds ratio, 3.15; 95% CI, 1.13-8.73 compared with patients with no or ≤10 CMBs).1

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August 15, 2016
Georgios Tsivgoulis, MD; Aristeidis H. Katsanos, MD; Andrei V. Alexandrov, MD
1Department of Neurology, University of Tennessee Health Science Center, Memphis2Second Department of Neurology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece3International Clinical Research Center, Department of Neurology, St Anne’s University Hospital in Brno, Brno, Czech Republic
2Second Department of Neurology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece4Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
1Department of Neurology, University of Tennessee Health Science Center, Memphis
JAMA Neurol. Published online August 15, 2016.;():. doi:10.1001/jamaneurol.2016.2937.
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