Cerebral microbleeds in patients with hypertensive stroke. Topographical distribution in the supratentorial area

To analyse the topography of cerebral microbleeds (CMBs) visualized by T2*-weighted gradient-echo MR imaging in the supratentorial brain area, based on the anatomical classification of the regions and the arterial territories.

CMBs are associated with hypertension and the risk of intracerebral hemorrhage; however, little is known about the cerebral topography of CMBs.

We examined 164 consecutive patients with hypertensive stroke who underwent T2*-weighted gradient-echo MRI. The anatomical locations and the vascular territories of the CMBs were determined in the subcortical white matter, basal ganglia/internal capsule and thalamus along the standard axial slices.

We detected 2,193 CMBs in 98 patients (13.4+/-39.0 per patient). The CMBs showed a significant predilection for the temporo-occipital area of the subcortical white matter, the posterolateral part of the upper putamen, and the lateral nuclei of the mid-level thalamus. The most common arterial territories were those of the middle-posterior cerebral artery in the white matter, the middle cerebral artery in the basal ganglia, and the thalamogeniculate artery in the thalamus.

These findings were quite similar to the cerebral topography of intracerebral hemorrhage described in the literature. Our results suggest that CMBs are regionally associated with intracerebral hemorrhage.