Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications
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1Department of Neurology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany. h.koennecke@keh-berlin.de
Objective:
To assess the potential role of cerebral microbleeds (CMB) in intracerebral hemorrhage (ICH), as indicators of cerebral small-vessel disease, and their possible implications for antithrombotic treatment.
Methods:
The author reviewed literature published through July 2005 from electronic MEDLINE, PubMed, and hand searches. CMB prevalence analyses were performed for subjects without cerebrovascular disease, with ICH, and with ischemic cerebrovascular disease.
Results:
Prevalence data from more than 5,200 subjects were analyzed. In elderly subjects without cerebrovascular disease, CMB prevalence is between 5% and 6%, associated with advanced age, while data are inconsistent with regard to CMB and chronic hypertension. CMB are prevalent in 68% of patients with spontaneous ICH and 40% of those with ischemic cerebrovascular disease. Cerebral microangiopathy (lacunes, leukoaraiosis) is associated with the highest prevalence (57%) of CMB among patients with ischemic stroke. In patients with suspected cerebral amyloid angiopathy (CAA) or Alzheimer disease, CMB are predominantly located in the cortical-subcortical area. Current data provide no evidence that CMB increase the risk of ICH among patients on antithrombotic treatment or those treated with thrombolysis for acute stroke.
Conclusions:
Cerebral microbleeds might indicate a higher risk of future intracerebral hemorrhage and may be a marker of cerebral small-vessel disease and cerebral amyloid angiopathy. However, more prospective data are required in order to confirm these assumptions. Recommendations to guide antithrombotic treatment based on the detection of cerebral microbleeds are presently not justified.
Insights
Cerebral microbleeds (CMB) may signal increased risk for future intracerebral hemorrhage (ICH) and indicate small-vessel disease. However, current evidence does not support adjusting antithrombotic treatment based on CMB detection.
Area of Science:
- Neurology
- Vascular Neurology
- Geriatric Neurology
Background:
- Cerebral microbleeds (CMB) are increasingly recognized as indicators of cerebral small-vessel disease.
- Their association with intracerebral hemorrhage (ICH) and implications for treatment are under investigation.
Purpose of the Study:
- To evaluate the role of CMB as potential predictors of ICH.
- To assess the significance of CMB in the context of cerebral small-vessel disease.
- To explore the implications of CMB for antithrombotic therapy.
Main Methods:
- A literature review of studies published up to July 2005 was conducted.
- Data from MEDLINE, PubMed, and hand searches were analyzed.
- Prevalence of CMB was examined in subjects without cerebrovascular disease, with ICH, and with ischemic cerebrovascular disease.
Main Results:
- CMB prevalence in elderly individuals without cerebrovascular disease is 5-6%, linked to age.
- CMB are found in 68% of spontaneous ICH patients and 40% of ischemic cerebrovascular disease patients.
- No current evidence suggests CMB increase ICH risk in patients on antithrombotic treatment or thrombolysis.
Conclusions:
- Cerebral microbleeds may indicate a heightened risk of future intracerebral hemorrhage.
- CMB are potential markers for cerebral small-vessel disease and cerebral amyloid angiopathy.
- Further prospective studies are needed; current data do not justify treatment modifications based on CMB detection.
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