الفهرس 
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Abstract
Cerebrovascular stroke is the 2nd leading causes of death after ischemic heart disease, responsible for approximately 11% of total deaths worldwide according to the world health organization (WHO Global Health Estimates 2020).
Tissue plasminogen activator (tPA) remains the only FDA approved thrombolytic drug for the treatment of acute ischemic stroke, however, its use is limited by the narrow therapeutic time window (<4.5 hours) and by hemorrhagic complication (Marshall, 2015).
Use of intravenous thrombolytic therapy for acute stroke is associated with better functional and neurological outcomes and significantly reduce the effect of stroke morbidity and mortality (Qin et al., 2018).
However the commonest complication of IVT is ICH(In the National Institute of Neurological Disorders and Stroke (NINDS) trials, symptomatic intracerebral hemorrhage (sICH) was defined as a computed tomography (CT)-documented hemorrhage within 36 hours of treatment, which was temporally related to deterioration in the patient’s clinical condition in the judgment of the clinical investigator (The NINDS t-PA Stroke Study Group, 1997).
The ECASS III trial defined sICH as a CT- or magnetic resonance imaging (MRI)-documented hemorrhage associated with clinical deterioration defined as an increase in the National Institutes of Heart Stroke Scale (NIHSS) score of 4 points or more or led to death and was determined to be the predominant cause of neurological deterioration (Hacke et al., 2008). Aim of this study is to discuss the relation between number of CMBs as independent factor of risk of ICH in patients receiving IVT and functional outcome after 90 days
In this study we have 33 patients have CMBs and 33 patients not having CMBs
Number of patients developed ICH were 20 patients.
According to our result Sociodemographic and Clinical data of the studied 66 patients with IVT: mean age (69), male, atrial fibrillation, mean NIHSS (17),and image finding of CMBs and WMLs significantly higher in patient with intra cerebral haemorrhage
And regarding to; multivariate logistic regression of risk factor associated with intra cranial haemorrhage we found that smoking, HTN, DM, AF, NIHSS more than 17, IVT more than 6 hours, high CMBs burden and white matter lesions are statistically significant in patients with intracerebral haemorrhage.
In our study according the baseline demographic, Clinical data and imaging of 66 stroke patients received IVT:
We found that HTN, AF, intial stroke severity represented by (mean NIHSS at admission and stroke in anterior circulation) were statistically significant higher in patients with CMBs, also presence of WMLs was significantly higher in patients with CMBs. And the Multivariate logistic regression of risk factor of CMBs shows that smoking, HTN, DM AF and WMLs are statistically significant higher in patients with CMBs.
In our study according to the relation between the distribution of CMBS and HTN we found that 9 of 10 patients were HTN with deep CMBS and 1 of 4 patients were with HTN th lobar CMBs and 16 of 19 patients were HTN mixed CMBs. This mean that HTN is more statistically significant in patient with deep CMBs than non HTN patients.
According to the Comparison between Patients with and without CMBS regarding functional outcome after 90 days measured by MRS in patients received IVT we found that patients with cerebral microbleeds had poorer functional outcome after 90 days than those without CMBs.
Also we did the relation between the number of CMBs and functional outcome after 90 days we found that, the more the number of CMBs in patients received IVT, the poorer the functional outcome after 90 days and the higher mortality rate.
Several limitations of our study have to be discussed. First, this study has a retrospective design, although the radiologic and clinical data were collected prospectively. Therefore, the potential risk of selection bias should be noted. Second, as time is brain, it means that clinical practice should focus on reducing the time delay to thrombolysis. Establishment of pre-IVT MRI protocol to detect CMBs may consume a longer time than CT-based protocol. Third, the use of IV Tpa outside of conventional time windows also limits our finding. Fourth, we could not include some potential confounders, for example, infarct volume, acute thrombus, clinical syndrome, concomitant treatments (antiplatelets, anticoagulants, and statins), early ischemic changes, or pre-stroke modified Rankin score.