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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
Charidimou A. The Dark Matter of Cerebral MicrobleedsImplications for Thrombolysis and Other Clinical Scenarios. JAMA Neurol. 2016;73(10):1255-1256. doi:10.1001/jamaneurol.2016.2948