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Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting
Charlotte Cordonnier1, Rustam Al-Shahi Salman, Joanna Wardlaw
1Division of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK. c-cordonnier@chru-lille.fr
Brain : a Journal of Neurology
|February 27, 2007
Summary
Brain microbleeds (BMBs) are common in stroke patients and associated with hypertension. More research is needed to understand their diagnostic and prognostic value.
Area of Science:
- Neurology
- Radiology
- Epidemiology
Background:
- Brain microbleeds (BMBs) are identified as small, round, low-signal foci on MRI GRE T2 sequences.
- BMBs may serve as biomarkers for microangiopathy or offer diagnostic and prognostic insights for stroke treatment.
Purpose of the Study:
- To systematically review and critically appraise the published literature on brain microbleeds.
- To assess the prevalence, diagnostic utility, and prognostic implications of BMBs.
Main Methods:
- A systematic review and critical appraisal of 54 studies (53 case series, 9073 participants) using QUADAS, STARD, and Cochrane principles.
- Data pooling from similar studies to determine BMB prevalence and associations.
Main Results:
- Prevalence: 5% in healthy adults, 34% in ischemic stroke, 60% in intracerebral hemorrhage (ICH).
- Higher prevalence in recurrent strokes (e.g., 44% recurrent ICH vs. 52% first-ever ICH).
- Associated with hypertension (OR 3.9) and diabetes (OR 2.2) in healthy adults; hypertension (OR 2.3) in cerebrovascular disease patients.
Conclusions:
- Significant study biases were identified, including variations in MRI parameters and inconsistent BMB definitions.
- BMBs are prevalent in cerebrovascular disease patients and associated with hypertension and diabetes.
- There is a critical need for better-designed studies to clarify the diagnostic and prognostic utility of BMBs and their impact on treatment decisions.
